In what the federal government called the “largest Justice Department healthcare fraud takedown in history,” 324 individuals — including 96 medical providers — have been arrested in connection with schemes that amount to $14.6 billion in fraud, according to a June 30 news release from the department.
The investigations span billing fraud, kickbacks, opioid diversion, genetic testing scams and other schemes, according to the release.
The Justice Department also seized $245 million in cash, luxury goods, cryptocurrency and other assets. CMS prevented $4 billion in false payments and suspended or revoked 205 providers’ billing privileges, and civil charges included cases involving $14.2 million in alleged fraud and $34.3 million in settlements, the release said.
Here is a breakdown of the alleged schemes, as detailed by the Justice Department:
Transactional fraud: More than $12 billion
- Operation Gold Rush, a nationwide investigation, involved $10.6 billion in false Medicare claims using stolen identities of more than 1 million Americans.
- Defendants used foreign straw owners, encrypted messaging and laundered money through cryptocurrency and shell companies.
- According to the release, $4.41 billion in payments were blocked, but $900 million was paid out.
- Other cases included a $703 million AI-enabled scam using fake beneficiary consents and a $650 million Arizona Medicaid scheme that exploited vulnerable populations with substandard addiction care.
Wound care fraud: $1.1 billion
- Medical professionals applied unnecessary amniotic allografts to elderly and hospice patients.
- Defendants received millions in kickbacks.
Opioid trafficking
- In a scheme involving 15 million pills, 74 defendants — including 44 licensed providers — were charged across 58 cases.
Telemedicing and genetic testing fraud: $1.17 billion
- Forty-nine individuals were charged in schemes involving fraudulent billing for telehealth services, genetic tests and durable medical equipment.
The post Physicians among 96 medical providers charged in $14B fraud crackdown appeared first on Becker’s ASC.
