National health care fraud and opioid takedown results in charges against 345 defendants responsible for more than $6 billion in losses
Two Montana nurse practitioners indicted in telemedicine fraud scheme for orthotic braces
BILLNGS — The U.S. Attorney's Office for the District of Montana, along with the U.S. Department of Justice, today announced historic national health care fraud and opioid enforcement actions as part of an investigation that includes the indictments of two Montana nurse practitioners accused of participating in a telemedicine scheme to defraud Medicare of almost $10 million.
Acting Assistant Attorney General Brian C. Rabbitt, of the Justice Department's Criminal Division, said the action involves 345 charged defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals.
These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.
“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,” said Acting Assistant Attorney Rabbitt. “These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain. The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency.”
The largest amount of alleged fraud loss charged in connection with the cases announced today – $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts – relates to schemes involving telemedicine: the use of telecommunications to provide health care services remotely.
According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen. Durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.
The continued focus on prosecuting health care fraud schemes involving telemedicine builds on the efforts and impact of the 2019 “Operation Brace Yourself” Telemedicine and Durable Medical Equipment Takedown, which resulted in an estimated cost avoidance of more than $1.5 billion in the amount paid by Medicare for orthotic braces in the 17 months following that takedown.
Two Montana indictments unsealed today separately charge nurse practitioners Mark Allen Hill, 54, of Edenburg, N.D., and whose address of record for participation in the Medicare program was Cut Bank, and Janae Nichole Harper, 33, of Kalispell and formerly of Billings, with conspiracy to commit health care fraud and health care fraud. Each defendant is accused of receiving money to sign unnecessary brace orders, often without ever talking to the Medicare beneficiary to determine whether the braces were medically necessary.
The indictment charging Hill alleges he signed fraudulent medical orders for braces resulting in more than $10 million in claims to Medicare, of which the government paid more than $5 million. Similarly, the indictment charging Harper alleges she signed fraudulent medical orders for braces resulting in more than $8 million in claims to Medicare, of which the government paid more than $4 million.
If convicted of the most serious crimes, Hill and Harper face a maximum 10 years in prison and a $250,000 fine. The indictments are merely accusations, and the defendants are presumed innocent until proven guilty. Arraignments for Hill and Harper are set for Oct. 27 in Great Falls before U.S. Magistrate Judge John T. Johnston. The cases are being prosecuted by Assistant U.S. Attorney Michael A. Kakuk and Robyn N. Pullio, trial attorney, Fraud Section, Criminal Division of the Justice Department. Pacer case reference numbers: 20-67 and 20-65.
Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, HHS-OIG, FBI, and DEA, as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic. The cases announced today are being prosecuted by Health Care Fraud and ARPO Strike Force teams from the Criminal Division’s Fraud Section, along with 43 U.S. Attorneys’ Offices nationwide, and agents from HHS-OIG, FBI, DEA, and other various federal and state law enforcement agencies.
The following documents related to today’s announcement are available on the Criminal Division, Fraud Section’s Health Care Fraud Unit website through the following links:
- Graphics, Images and Resources: https://www.justice.gov/criminal-fraud/hcf-2020-takedown/graphics-images-resources
- Case Descriptions: https://www.justice.gov/criminal-fraud/hcf-2020-takedown/case-descriptions
- Court Documents: https://www.justice.gov/criminal-fraud/hcf-2020-takedown/court-documents