Tag Archives: Affordable Care Act

DOJ Announces Charges Against 400 People for $1.3 Billion in Health-Care Fraud

Posted by Devaki Sidhaye.

Recently department of Justice announced largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 individuals, including 115 doctors, nurses and other licensed medical professionals. Their involvement in health care fraud scams totaling approximately $1.3 billion in false billings. As per the department, many of the charges were related to medical professionals illegally prescribing opioids and other prescription narcotics, some of which were then sold on the street. Furthermore, according to federal officials, a rehab facility in Palm Beach, Fla., recruited addicts with gift cards, drugs and visits to strip clubs, billed the government for over $58 million in false treatments and tests. A clinic in Houston allegedly gave out prescriptions for cash. Some falsely billed Medicare and Medicaid. Narcotics officers have arrested schoolteachers, doctors, nurses and fellow law enforcement personnel (Merle, 2017).

According to the Centers for Disease Control and Prevention, approximately 91 Americans die every day of an opioid related overdose. Attorney General Jeff Sessions said at a news conference that, “One American dies of a drug overdose every 11 minutes and more than 2 million Americans are ensnared in addiction to prescription painkillers.” He further said in assurance that, “We will continue to find, arrest, prosecute, convict and incarcerate fraudsters and drug dealers wherever they are.” Health and Human Services Inspector General Daniel Levinson added that, “Health care fraud is a reprehensible crime, it not only represents a theft from taxpayers who fund these vital programs, but impacts the millions of Americans who rely on Medicare and Medicaid” (Merle, 2017).

This approaches a larger debate about how the country should address the government estimates are addicted to opioids. Public health authorities urge doctors to cut back on the prescriptions they offer. States struggling with the shortage of treatment has proposed roll back of the Affordable Care Act’s expansion of Medicaid (Merle, 2017).

This crisis represents a massive public health challenge that requires a broad-based, multi-pronged response from public health agencies and law enforcement. Physicians, pharmacists and citizens all can play a role in identifying and preventing nonmedical use of prescription drugs. Doctors and other healthcare professionals who prescribe these drugs need to be educated about responsible prescribing of opioids and about safe, effective alternatives that are not addictive and presently available (Young, 2016).

Even though law enforcement officials use advanced investigative methods to uncover the different actions health care fraud happens, they can’t fight these crimes alone. Individual can help remove these people responsible for wrongdoings by protecting their health insurance identification number, social security number, looking through the statements for medical services he didn’t receive, and reporting to authorities on recognizing the signs of possible fraud (Outreach, 2012).

For the protection of each person of the country as well as for the economic strength it is essential to destroy all traces of health care fraud. Health care frauds damage billions of dollars of the nation; mislead general public in the courses of actions, and innocent people become victims of white-collar crime.

Devaki is an MS Accounting student at the Feliciano School of Business, Montclair State University, Class of 2018.


Merle, S. H. (2017, 07 13). DOJ announces charges against 400 people for $1.3 billion in health-care fraud. Retrieved from www.washingtonpost.com: https://www.washingtonpost.com/news/business/wp/2017/07/13/doj-announces-charges-against-400-people-for-1-3-billion-in-health-care-fraud/?utm_term=.f9b959fbfea6

Outreach, E. &. (2012, 04 23). How to Protect Yourself From Health Care Scams. Retrieved from www.aarp.org: http://www.aarp.org/health/medicare-insurance/info-10-2010/fightfraud.html

Young, L. (2016, 03 04). There’s no debate – America’s opioid epidemic is undeniable. Retrieved from www.pennlive.com: http://www.pennlive.com/opinion/2017/09/heres_what_you_need_to_know_ab_5.html