Remarks as Prepared for Delivery
Good morning and thank you for joining us today. We are here this morning to announce the results of truly historic nationwide law enforcement operations led by the Criminal Division’s Health Care Fraud Strike Force Program — part of the Criminal Division’s Fraud Section.
From April of this year to today, the Criminal Division, along with our colleagues in U.S. Attorneys’ Offices around the country and our partners in law enforcement — including the Federal Bureau of Investigation, the Department of Health and Human Services-Office of the Inspector General, and the Drug Enforcement Administration — have charged more than 300 individuals with schemes involving more than 6 billion dollars in alleged healthcare fraud and millions of prescription opioids.
Measured solely by the amount of loss these defendants are alleged to have caused the federal government and other third-party payors, today’s announcement marks the largest amount of fraud ever charged by the department in a single National Takedown.
Our efforts represent a continuation of the department’s ongoing work to combat the devastating effects of healthcare fraud and opioid abuse across the country. And while this effort has been led by our Fraud Section’s Health Care Fraud Unit, it truly reflects a nationwide effort, with the department bringing cases in more than 50 separate federal districts and participation by over 40 U.S. Attorneys’ Offices across the country.
These cases involve charges against a wide variety of people, with charges brought against more than 100 licensed medical professionals, including more than 50 doctors, and more than 20 healthcare company executives.
These cases also cover a wide variety of alleged healthcare fraud and illegal prescription opioid schemes.
Some schemes, unfortunately, are all too familiar to us from our work over the last several years. These include schemes with defendants who allegedly billed for millions of dollars’ worth of products and services they simply never provided, or where defendants allegedly prescribed and billed for medically unnecessary treatments and medications — including powerfully addictive and destructive opioids.
These cases also represent a number of new schemes that we are charging for the first time. These schemes reflect what we believe to be harmful trends that appear to be emerging in healthcare fraud. We are tracking these new trends and responding aggressively, as today’s announcement demonstrates.
These cases, of course, are only the latest in the department’s years-long effort to safeguard the nation’s healthcare programs from fraud and abuse. Since 2017, the Criminal Division’s Fraud Section has charged more than 1,000 individuals with more than 10 billion dollars in healthcare fraud, including fraud related to the abuse of opioids.
Preventing and imposing accountability for healthcare fraud has never been of more critical importance than it is today, and these prosecutions once again show the Criminal Division and its partners efficiently and effectively striking at those who abuse America’s healthcare programs.
Now, let me take a moment to speak briefly about the types of alleged criminal schemes charged in this Takedown.
The largest amount of fraud charged in the cases announced today — representing more than 4.5 billion dollars of alleged fraud — relates to telemedicine: that is, the use of telecommunications technology, like the phone or the internet, to provide healthcare services remotely rather than in person.
That ability to provide healthcare remotely is a critical tool for those who might be homebound, in remote areas, or otherwise unable to visit their healthcare provider in person.
And telemedicine has proven all the more critical during this national crisis, when so many Americans are isolating, quarantining, or otherwise restricting their face-to-face interactions.
However, a number of the cases we are announcing today show that for all of its benefits, telemedicine, unfortunately, also can be exploited by criminals.
For example, in a case charged in the District of New Jersey, a group of defendants allegedly submitted over 522 million dollars of false and fraudulent bills for genetic testing to Medicare as part of a telemedicine scheme that involved patients in all 50 states, D.C., and the Virgin Islands.
We are also announcing charges brought in the Northern District of Illinois against a doctor who is alleged to have been the highest prescriber of genetic testing in the country — the largest such case to date, involving 145 million dollars in alleged fraud loss.
As I said earlier, telemedicine offers great promise to Americans, especially during this difficult time, and we at the department remain committed to ensuring that that promise is not undermined by fraud and abuse.
Another sizeable amount of fraud that we are announcing today — nearly 850 million dollars’ worth — relates to doctors and others who allegedly defrauded insurance providers and their own patients in connection with residential substance abuse treatment centers, or so-called “sober homes.”
These are facilities that are supposed to provide life-saving care and treatment to some of the most vulnerable among us: those battling addiction.
But, unfortunately, there are those who would prey on these vulnerable individuals and illegally seek to exploit the system for their own financial benefit.
For example, we have charged ten defendants, including a CEO, two clinic owners, and three doctors, in connection with a 91 million dollar fraud scheme involving inpatient and outpatient addiction treatment centers in Broward County, Florida.
This comes on the heels of charging — this summer in South Florida — the largest-ever “sober homes” fraud case, involving over 680 million in alleged fraud.
These “sober homes” cases are particularly egregious, not just because of the substantial amounts of financial loss they cause, but also because of the significant harm they cause to patients who are used and abused along the way.
In many of these cases, defendants are alleged to have preyed upon addicted patients, recruiting them from their hometowns, where they have support networks, and shipping them off to far-away states where they are placed into these so-called “sober homes.” Once there, these vulnerable patients are often provided with drugs that undercut their ability to recover from the addiction they are trying to kick, and they are often shuffled from facility to facility to boost headcount and maximize billing, instead of being given the care they so desperately need.
In some of our more troubling cases, and as alleged in the relevant charging documents, some patients also are referred out to other healthcare providers, who bill for additional medically unnecessary tests, medications, and services; other co-conspirators then provide kickbacks in return for access to these vulnerable patients. This fraud and abuse truly inflict a human — not just financial — toll on their victims.
We are also announcing cases today that are part of our ongoing efforts to combat the scourge of opioid abuse, charging doctors, lab owners, and others responsible for the illegal prescription and distribution of devastatingly addictive opioid medications.
In two of these cases alone — one charged in the Northern District of Alabama and the other in the Southern District of Ohio — the defendants, including doctors and lab owners, are alleged to have been responsible for fraud schemes totaling over 40 million dollars that involved prescription and distribution of more than 27 million doses of opioids.
These cases are only the latest efforts in the department’s ongoing response to the nation’s opioid epidemic, and they follow the Criminal Division’s 2018 creation — with our U.S. Attorney’s Office and law enforcement partners — of the Appalachian Regional Prescription Opioid Strike Force. The Department of Justice is committed to fighting the opioid epidemic that is plaguing America, and this Takedown is just the latest example of our work in this important area.
These are just several examples of the types of cases we are announcing today as part of this National Healthcare Fraud and Opioid Takedown.
It is, of course, important to remember that the charges I’ve referred to today are merely allegations against these defendants; the defendants are presumed innocent until they are found guilty beyond a reasonable doubt.
But I highlight these cases to demonstrate the diversity and variety of schemes at which we are taking aim, and to emphasize the department’s comprehensive approach to bringing accountability to those who would steal taxpayer dollars for personal gain.
Before I turn the podium over to our law enforcement partners, let me take a moment to mention a few points about that comprehensive approach.
First, I want to note the unparalleled interagency cooperation — led by our Fraud Section’s Health Care Fraud Unit, but dependent on our partners — that makes today’s announcement possible.
These cases are a reflection of the strong partnerships we have developed with our law enforcement partners, our colleagues in U.S. Attorneys’ Offices around the country, and other federal agencies.
Let me give you a concrete example of that partnership.
In addition to the cases we are announcing today, the Centers for Medicare and Medicaid Services, Center for Program Integrity has imposed more than 250 billing privilege revocations to further ensure the integrity of federal healthcare programs. These revocations immediately prevent further wrongful dissipation of taxpayer-funded healthcare resources, and the size, scope, and speed of our CMS-CPI partners’ action on these revocations is an enormously important tool in our efforts to combat healthcare fraud.
I want to recognize and thank all of our partners for their efforts in today’s cases and in combatting fraud against our nation’s healthcare programs.
The second point I want to highlight about the cases we’re announcing today is the Criminal Division’s agility in responding to existing, as well as new and emerging, threats.
Two examples of this can be seen at work in certain of the cases charged in today’s Takedown.
First, just this year, the Criminal Division’s Fraud Section created a new team called the “National Rapid Response Strike Force.”
This team complements the Fraud Section’s geographically targeted Health Care Fraud Unit prosecutors already operating in several strategic locations throughout the country.
The new team’s mandate is to address significant, multi-district fraud schemes wherever they occur, ensuring federal resources can be deployed at a moment’s notice to respond to new and emerging threats to the nation’s healthcare system.
And some of the cases announced today are the direct result of the work of this new team of prosecutors.
A second example is our use of data analytics. You’ve heard me talk before about the Criminal Division’s pioneering use of data to strategically target wrongdoing in a number of different areas. Many of these prosecutions are the direct result of our use of data analytics. The Fraud Section, in close partnership with our friends at the FBI, HHS-OIG, and the DEA, routinely applies cutting-edge data analytics to quickly identify, investigate, and prosecute healthcare fraud and the illegal prescription and distribution of opioids.
This data-driven approach will continue to be a vital tool utilized by federal law enforcement to identify, investigate, and prosecute criminal activity in this space.
The last point I’ll make goes to the significance of being able to announce a law enforcement operation of this size at this time.
The challenges our country faces as a result of the COVID-19 pandemic are many, and our prosecutors and law enforcement partners are by no means exempt from them.
On a professional level, these challenges have included court closures, travel restrictions, and limits on the sort of in-person and face-to-face interaction through which so much of our law enforcement activity occurs.
But I am proud to say that, as today’s results demonstrate, these challenges have not stopped us — or even slowed us down one bit. We have not allowed the challenges presented by the ongoing pandemic to prevent us from doing our job for the American people.
In fact, each of the cases we’re announcing today has been brought in the months since the President declared a National Health Emergency earlier this year.
Despite all of the personal and professional challenges that every one of the prosecutors, agents, and staff have faced during these extraordinary times, we have not wavered in our commitment to protecting the American people from fraud. And we will continue to remain vigilant, no matter what challenges we may face in the future.
My thanks go to all those here in the department — in particular, those in the Fraud Section’s Health Care Fraud Unit, our partnering U.S. Attorney’s Offices, and law enforcement personnel from the FBI, HHS, and DEA — all of whom, working together in close collaboration, made today possible.
But we have much more to do.
Going forward, we will continue to identify, investigate, and prosecute healthcare fraud schemes that seek to steal taxpayer funds, and which far too often come at the expense of patients’ care and well-being.