National Healthcare Fraud Takedown Results In Charges Against 601 Individuals Responsible For $2 Billion In Fraud Losses
HARRISBURG - 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 601 charged defendants across 58 federal districts, including 165 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 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 587 providers, including doctors, nurses and pharmacists.
Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney 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, Administrator Seema Verma of the Centers for Medicare and Medicaid Services (CMS), 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, and State Medicaid Fraud Control Units.
The charges announced today aggressively target schemes billing Medicare, Medicaid, and TRICARE (a health insurance program for members and veterans of the armed forces and their families) 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.”
“The level of this public health crisis demands extraordinary efforts in the areas of Health Care Fraud and Drug Diversion,” said United States Attorney David J. Freed. “We will not waver in our efforts to reduce the amount of drugs on our streets and the deaths that so often follow their over prescription and misuse. Today’s nationwide takedown involving substantial cooperation across federal and state agencies helps us send a strong message: This must stop.”
“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.”
“Health care fraud is not a victimless crime – it affects every one of us,” said Maureen Dixon, Special Agent in Charge for the U.S. Department of Health & Human Services Office of Inspector General. “We will continue to work with our law enforcement partners to bring these criminals to justice, return stolen dollars back to our government health care programs, and protect our most vulnerable citizens.”
“The distribution of controlled substance medications for no legitimate medical purpose by a registrant and individuals seeking to obtain them by fraud or forgery is a tremendous threat to the community in which these medications are diverted,” said Jon Wilson, Special Agent in Charge of the Drug Enforcement Administration’s (DEA) Philadelphia Field Division. “The DEA will continue to investigate any registrant suspected of misusing or abusing their privileges as well as any individual that is seeking to obtain these medications by fraud or other unlawful means. DEA greatly appreciates the coordinated efforts of all the agencies participating in this investigation.”
“Not only did Doctor Stremmel prescribe controlled substances to patients outside of medical necessity, he also falsified records in order to cover his tracks in patient files,” Attorney General Josh Shapiro said. “Thanks to U.S. Attorney David Freed’s office and cooperation with our other law enforcement partners, this man will be held accountable.”
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid and TRICARE 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. 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.
The United States Attorney's Office for the Middle District of Pennsylvania charged Robert L. Stremmel, age 74, of York, Pennsylvania on June 27, 2018, with dispensing opiates and amphetamines outside the course of a professional practice and not for a legitimate medical purpose. The indictment alleges that between July 2013 and January 2018, Stremmel distributed to one person more than 21,000 tablets of oxycodone and dextroamphetamine-amphetamine, both Schedule II controlled substances. The indictment also charges Stremmel with prescribing Xanax, codeine, and Tramadol, Schedule IV and V controlled substances. It is alleged that Stremmel intentionally prescribed these controlled substances outside the usual course of professional practice and not for a legitimate medical purpose. The indictment further charged Stremmel with making a false statement related to a health care matter for allegedly falsifying medical records in conjunction with a Medicare claim.
Diversion Investigators with the Drug Enforcement Administration, Special Agents with the Office of Inspector General for the Department of Health and Human Services and Special Agents with the Pennsylvania Office of Attorney General-Medicaid Fraud Control Section conducted this investigation with assistance from the East Lampeter Township Police Department.
Also charged in four indictments were ten residents of Cumberland and Perry County with obtaining possession of oxycodone, a Schedule II Controlled Substance, by misrepresentation, fraud and forgery. Charged in the indictments are:
- Pauline M. Wolfe, age 62, of Carlisle, PA;
- Bruce A. Greenwald, age 40, Mechanicsburg, PA;
- Angela L. Greenwald, age 40, Mechanicsburg, PA;
- Charles J. Greenwald, age 31, of Carlisle, PA;
- Heather Amanda Wolfe, age 27, of Carlisle, PA;
- Megan Nico Bergstresser, age 31, Carlisle, PA;
- Amy Beth Jones, age 32, Mechanicsburg, PA;
- Joseph Benjamin Shatto, age 28, of Carlisle, PA;
- Melissa L. Hunsicker, age 43, of Enola, PA;
- David Allen Hunsicker, age 48, of Dillsburg, PA.
The indictments allege that between December 2016, and June 2017, the defendants conspired with each other and others to create false, fraudulent and forged prescriptions for oxycodone. Several of the defendants were also charged with making false statements in connection with payment of health care benefits. The indictment also alleges several defendants used the Medicare and Medicaid program benefits to pay for the forged prescriptions they filled at area pharmacies. At least three of the defendants stole the identities of Medicare and Medicaid beneficiaries to obtain payment for the fraudulently obtained opioids. The conspiracy is alleged to have resulted in the unlawful possession of approximately 10,000 oxycodone tablets.
Special Agents of the Office of Inspector General (OIG) for the United States Department of Health and Human Services and Diversion Investigators with the Drug Enforcement Administration (DEA) conducted this investigation. On June 26, 2018, OIG, DEA, Carlisle Police Department, Mechanicsburg Police Department, Marysville Police Department, West Shore Regional Police Department, Pennsylvania State Police, Perry County Sheriff’s Department, BNI and Cumberland County Sheriff’s Department searched for and executed arrest warrants for the defendants. Assistant United States Attorney Joseph Terz is prosecuting both cases.
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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