U.S. charges hundreds in major healthcare fraud, opioid crackdown

U.S. charges 601 people in health care fraud opioid takedown

"In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets", Attorney General Jeff Sessions said in a statement. In 2016, 116 people died every day from opioid-related drug overdoses, and over eleven million people misused prescription opioids.

Of that staggering total, about 125 defendants were charged in South Florida with filing almost $340 million in fraudulent claims for opioid addiction treatment, home healthcare and prescription drugs covered by taxpayer-funded programs and other insurance plans.

Dr. Kim allegedly took part in a scheme to submit claims to Medicare for physical therapy services that were not medically necessary, not provided, or otherwise did not qualify for reimbursement. Crosby is accused of paying an alleged co-conspirator to recruit patients by promising them cash or other inducements, and Crosby allegedly billed for services not rendered, they said. About $858,000 was paid out in fraudulent proceeds as a result, he said.

The alleged scheme - spearheaded by Michael Drobot, the previously convicted former owner of Pacific Hospital in Long Beach - involved more than $40 million in illegal kickbacks paid to doctors and other medical professionals in exchange for referring thousands of patients who received surgeries and other services at Pacific Hospital.

This announcement appears to reflect both an ongoing commitment by the DOJ to prosecute health care fraud and opioid abuse cases, and that the emphasis by HHS on administratively excluding providers has become a part of the enforcement landscape over the past year. Several face charges of unlawfully dispensing controlled substances, including Dr. Peter Steiner, a psychiatrist who operated Kentuckiana Mental Health Associates, who is accused of prescribing unnecessary drugs.

The takedown is considered to be one of the largest health care fraud busts in U.S history.

Ashlee McFarlane, former federal prosecutor and partner at Gerger Khalil & Hennessy, told Healthcare Dive via email that the takedown shows DOJ "is committing significant resources to criminally prosecuting anyone who prescribes drugs or distributes opioid prescriptions outside the normal course of medical practice". The Medicare Fraud Strike Force operates in nine locations nationwide.

Yesdel Acosta and Eduardo Chinea-Martinez were charged with one count of conspiracy to commit health care fraud, 16 counts of health care fraud, 13 counts of theft from a health care benefit program, 13 counts aggravated identity theft, 10 counts of money laundering and four counts of mail fraud.

A complaint, information, or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

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