Rapid Response Strike Force

National Rapid Response Strike Force

The National Rapid Response Strike Force’s mission is to (1) investigate and prosecute the country’s largest and most complex health care fraud cases, with a focus on individuals, corporations, and matters that have a significant impact on a wide variety of public and private health care insurance payors; (2) coordinate nationwide enforcement actions and multi-jurisdictional investigations by providing support and subject matter expertise to the Health Care Fraud Unit’s Strike Forces and U.S. Attorney’s offices across the country; and (3) enable the Fraud Section to quickly tackle new issues of national priority and emerging trends in health care fraud schemes, as identified through data analytics and partnerships with the Civil Division’s Fraud Section and Consumer Protection Branch, U.S. Attorney’s offices, state Medicaid Fraud Control Units, the FBI, HHS-OIG, and other agencies.  The National Rapid Response Strike Force is composed of some of the country’s most experienced health care fraud prosecutors, including former Assistant U.S. Attorneys, law firm partners, and Trial Attorneys with decades of courtroom experience.

The National Rapid Response Strike Force’s recent successes reflect the effectiveness of this model.  For example, the National Rapid Response Strike Force has led and coordinated the Department’s nationwide initiatives, as well as its prosecution of cases involving corporate health care fraud, telemedicine, sober homes, and COVID-19 fraud.

National Enforcement Actions:  The National Rapid Response Strike Force led and coordinated the following recent national enforcement actions:

• 2024 National Health Care Fraud Enforcement Action, which involved criminal charges against 193 defendants, including 76 doctors, nurse practitioners, and other licensed medical professionals, in 32 federal districts across the United States, for their alleged participation in various health care fraud schemes involving approximately $2.75 billion in intended losses and $1.6 billion in actual losses.
• 2023 National Health Care Fraud Enforcement Action, which involved criminal charges against 78 defendants for their alleged participation in health care fraud and opioid abuse schemes involving over $2.5 billion in alleged fraud.
• 2022 Telemedicine Enforcement Action, which involved criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment schemes.

Corporate Health Care Fraud:  In corporate health care fraud prosecutions, the National Rapid Response Strike Force in 2022 obtained the convictions of the owners of rural hospitals for a $1.4 billion pass-through billing scheme that used the hospitals as vehicles to submit fraudulent claims for lucrative laboratory testing.  In this scheme, individuals took over small, rural hospitals with in-network contracts, which often were in financial trouble.  They then billed private insurance companies through those hospitals for expensive and often medically unnecessary testing conducted at out-of-network laboratories with which they had a relationship.  This was one of the largest health care fraud cases ever charged and involved first-in-the-nation charges for rural hospital billing fraud.

In September 2022, the National Rapid Response Strike Force also obtained, in collaboration with the Fraud Section’s Market Integrity and Major Frauds Unit, the conviction of the president of a California-based medical technology company in connection with his participation in schemes to mislead investors, manipulate the company’s stock price, and conspire to commit health care fraud in connection with the submission of over $69 million in false and fraudulent claims for allergy and COVID-19 testing.  The case was the first criminal securities fraud prosecution related to the COVID-19 pandemic that was brought by the Department of Justice, and the National Rapid Response Strike Force has recently brought additional cases involving financial and health care fraud by medical technology companies.

These recent successes at trial build on prior corporate health care fraud work.  Examples of successful corporate health care fraud prosecutions include the resolution with a major U.S. hospital chain, Tenet Healthcare Corporation, and two of its Atlanta-area subsidiaries, which paid over $513 million to resolve criminal charges and civil claims relating to a scheme to defraud the United States and to pay kickbacks in exchange for patient referrals. 

Telemedicine:  In five successive enforcement actions, the National Rapid Response Strike Force has led efforts to bring charges and secure guilty pleas involving over $10 billion in alleged telemedicine fraud.  In these schemes, telemedicine company executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic tests, and pain and other medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.  Often, patients were lured into the scheme by transnational telemarketing networks, and the durable medical equipment, test results, and medications were not provided to the beneficiaries or were worthless to the patients and their actual primary care doctors, while the misdirection, fake diagnoses, and unneeded tests misled patients and delayed their chance to seek appropriate treatment for medical complaints.  Proceeds of the fraudulent schemes were allegedly laundered through international shell corporations and foreign banks.

These efforts have obtained direct results for American taxpayers:  CMS-CPI has calculated that the deterrent impact of just one of the telemedicine enforcement actions was an estimated cost avoidance of over $1.9 billion in the amount Medicare paid for orthotic braces in the time after that enforcement action due to a drop in claims.  This preserved the Medicare trust fund for legitimate medical care.

Sober Homes Initiative: The National Rapid Response Strike Force leads the national Sober Homes Initiative that targets physicians, owners, and operators of substance abuse treatment facilities, and patient recruiters (also known in the industry as “body brokers”).  These individuals sacrifice genuine care and prey upon those suffering with substance abuse issues by offering them illegal financial incentives to enroll at certain facilities, billing for medically unnecessary therapy and/or therapy never actually provided, billing private insurers for excessive and medically unnecessary urine drug testing, and perhaps most tragically, preventing patients needing help from getting the care they need.  Medical professionals also prescribed controlled substances and other medications outside the scope of medical practice, and even to entice patients to stay at the facility.  The consequences in terms of patient harm can be significant – addictions go unaddressed and patients can even overdose.

The Sober Homes Initiative has resulted in charges and guilty pleas involving 27 criminal defendants in connection with over $1 billion in alleged false billings for fraudulent tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.  In 2022, National Rapid Response Strike Force prosecutors obtained convictions in four separate Sober Homes trials in the Southern District of Florida that collectively involved hundreds of millions of dollars in fraud and significant harm to addicted patients.

Coronavirus Response: The National Rapid Response Strike Force has assumed a leadership role in chairing the interagency COVID-19 fraud working group and working with federal law enforcement and public health agencies to identify and combat health care fraud trends emerging during the COVID-19 pandemic.  This involved coordination and training of other Strike Forces and U.S. Attorney’s Offices regarding COVID-19 health care fraud scams and offering support to their investigations and prosecutions.  The collaborative, nationwide response facilitates information sharing to quickly identify, investigate, and prosecute COVID-19 health care fraud schemes.        

Examples of cases prosecuted to date include cases against corporate executives, medical professionals, laboratory owners, and marketing organizations in connection with schemes to offer free COVID-19 testing to obtain Medicare beneficiary information that is then used to submit claims for unrelated and medically unnecessary (or unprovided) tests or services; to submit claims for unordered and unnecessary respiratory pathogen panel tests added on to COVID-19 tests; and to profit from distributing fake vaccine cards.  

Recent Cases: Below are some recent National Rapid Response Strike Force cases.

• United States v. Anagho (D. Az.) – Treatment center owner charged with alleged $69 million substance abuse treatment fraud
• United States v. Blackman, et al. (S.D. Fl.) – Software and services company executives charged with alleged $1 billion telemedicine fraud
• United States v. Diamantstein (DNJ) – Wholesale pharmaceutical distribution company owner charged with alleged $150 million prescription HIV medication diversion scheme
• United States v. Gehrke, et al. (D. Az.) – Wound care company owners charged with alleged $900 million amniotic wound graft fraud
• United States v. Gray (N.D. TX) – Laboratory owner charged with alleged $335 million cardiovascular genetic testing fraud
• United States v. He, et al. (N.D. Cal.) – Digital health company founder/CEO and clinical president charged with alleged $100 million Adderall distribution and health care fraud scheme
• United States v. Navarro (C.D. Cal.) – Laboratory owner charged with alleged $455 million respiratory pathogen panel testing fraud