National Healthcare Fraud Takedown Results in Charges Against 590+ Individuals Responsible for $2+ Billion in Fraud Losses
As a part of the largest Health Care Fraud Enforcement Action in Department of Justice History, The Eastern District of Louisiana Strike Force Announces Charges Against Eleven Individuals.
WASHINGTON - Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 590+ charged defendants across 56 federal districts, including 150+ doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $2 billion in false billings. Of those charged, over 150 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Twenty-nine state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS announced today that from June 2017 to the present, 587 providers have been served with exclusion notices for conduct related to opioid diversion and abuse.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Inspector General Daniel R. Levinson of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Director Alec Alexander of the Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG. In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department. According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes. That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud. I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible. By every measure we are more effective at finding and prosecuting medical fraud than ever.”
“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar. “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
Cases within the Eastern District of Louisiana include:
United States v. Luis Cabrera, Jr., et al. (E.D. La) (Opioids): On June 22, 2018, Luis R. Cabrera, Jr., Victoria J. Skeldon, Bennie R. Harris, Jesse J. Wildenfils, Stephanie N. Free, Jarrod A. Doubleday, John A. Doubleday, Whitney J. Swan, III, Stephanie M. Faciane, and Cynthia B. Foret, were charged in a twelve-count indictment related to their roles in violating the Controlled Substances Act. Cabrera, Jr., Skedon, Harris, Wildenfils, Free, Jarrod Doubleday, John Doubleday, Swan, III, and Faciane were charged with a dual-object conspiracy to acquire and obtain oxycodone by fraud and to possess oxycodone with the intent to distribute. Cabrera, Jr., and Skeldon were each charged with one count of possession of oxycodone with the intent to distribute. Harris, Wildenfils, Free, Jarrod Doubleday, John Doubleday, Swan, III, and Faciane were each charged with one count of obtaining oxycodone through fraud. Cabrera, Jr. and Foret were charged with a dual-object conspiracy to acquire and possess oxycodone through fraud and to possess oxycodone with the intent to distribute. Cabrera, Jr. and Foret were also charged with one count of possession of oxycodone with the intent to distribute.
The charges stem from the defendant’s involvement in a prescription drug ring in the greater New Orleans area where the defendants used stolen fraudulent prescriptions to obtain and sell oxycodone pills. U.S. Attorney Evans praised the investigative work by the Federal Bureau of Investigation, HHS-OIG, the Drug Enforcement Administration, and the Jefferson Parish Sheriff’s Office. The case is being handled by DOJ Trial Attorney Jared Hasten and Assistant United States Attorney Myles Ranier (AUSA).
United States v. Wayne Jerome Celestine (E.D. La) (Opioids): On June 27, 2018, U.S. Attorney Duane A. Evans announced the unsealing of a superseding indictment against Wayne Jerome Celestine, age 57, a physician who practices in Gretna, Louisiana and resides in the New Orleans area. The superseding indictment contained the original charge of distribution of controlled substances, plus a money laundering charge involving approximately $1.6 million.
On Monday, April 30, 2018, Dr. Celestine was arrested. According to court records, Dr. Celestine illegally dispensed and conspired with others to illegally dispense controlled substances, including oxycodone, oxycodone/acetaminophen, oxycontin HCL, oxymorphone HCL, hydromorphone, opana, fentanyl, suboxone, and morphine sulfate, a Schedule II drug controlled substances; hydrocodone/acetaminophen, a Schedule III drug controlled substance until October 6, 2014, thereafter, a Schedule II drug controlled substance; and alprazolam, diazepam, and carisoprodol, Schedule IV drug controlled substances.
Celestine made his initial appearance on the original indictment before U.S. Magistrate Court Judge Daniel E. Knowles, III, on Monday, April 30, 2018. A detention hearing was held on May 1, 2018, and he was detained.
If convicted of the original charge (Count 1), Celestine will face a maximum of not more than 20 years in prison on the drug conspiracy charge, pursuant to Title 21, United States Code, Sections 841(a)(1) and 846. Celestine will also be subject to a fine of not more than one million dollars and a minimum term of supervised release of three years, following any term of imprisonment.
If convicted on the new additional charge (Count 2), Celestine faces not more than 20 years in prison, a $500,000 fine or twice the value of property involved, and three years of supervised release.
U.S. Attorney Evans praised the work of the Special Agents of the Drug Enforcement Administration, Internal Revenue Service, Jefferson Parish Sheriff’s Office, Harahan Police Department, Westwego Police Department, Louisiana State Police, St. Bernard Parish Sheriff’s Office, New Orleans Police Department, and New Orleans District Attorney’s Office in investigating this matter. Assistant United States Attorney John F. Murphy is in charge of the prosecution.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
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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