National Health Care Fraud Takedown Results In Charges Against 601 Individuals Responsible For Over $2 Billion In Fraud Losses
Largest Health Care Fraud Enforcement Action in Department of Justice History Resulted in 76 Doctors Charged and 84 Opioid Cases Involving More Than 13 Million Illegal Dosages of Opioids
LAS VEGAS, Nev. – The largest ever health care fraud enforcement action by the Department of Justice includes four Nevada residents who were charged with conspiracy to distribute prescription opioids and health care fraud, announced U.S. Attorney Dayle Elieson for the District of Nevada.
Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced today the national health care fraud takedown involved 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 more than $2 billion in false billings. Of those charged, 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 announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.
“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.”
“Prescription opioid-related health care fraud is a serious problem,” said U.S. Attorney Elieson. “Medical professionals hold a special place of trust in our society as healers, caregivers, and lifesavers. Doctors who violate their oath to ‘do no harm’ by illegally prescribing opioids for no medical necessity or file fraudulent health care bills will be held accountable.”
As part of the announcement, the District of Nevada filed charges against four individuals, including one doctor, with prescription opioid-related offenses. The cases have a combined loss of approximately $3.7 million.
- Robert D. Harvey, a surgical technician, Alejandro Incera and Leslie Kalyn, both nurse practitioners, were charged in a 29-count indictment. As alleged, Harvey and Incera conspired to use Dr. Horace Guerra’s pre-signed prescription pad to distribute Hydrocodone and Oxycodone to patients without a legitimate medical purpose in exchange for cash kickbacks. Incera and Kalyn allegedly prescribed Lidocaine, Modafinil, and Diclofenac Sodium to patients without a legitimate medical purpose, many of which were billed to Medicare/Medicaid by a pharmacy that filled the prescriptions. Harvey, Incera, and Kalyn were paid cash kickbacks for their patient referrals to the pharmacy. A jury trial is set for July 30, 2018.
- Dr. Horace P. Guerra was charged with conspiracy to distribute Oxycodone and Hydrocodone. As alleged, he provided pre-signed prescription pads to Robert Harvey and Alejandro Incera who wrote opioid prescriptions for patients without a legitimate medical purpose. His initial court appearance and plea hearing is set for July 25, 2018.
These charges are the result of joint investigations by the FBI, the Office of Inspector General of the U.S. Department of Health and Human Services, and the Nevada Attorney General’s Office Medicaid Fraud Control Unit. Assistant U.S. Attorney Kilby Macfadden is prosecuting these cases.
The Opioid Fraud and Abuse Detection Unit is a program that utilizes data to help combat the devastating opioid crisis. The District of Nevada was selected as one of 12 districts nationally to participate in the pilot program. The District of Nevada has assigned an experienced prosecutor that focuses solely on investigating and prosecuting health care fraud related to medical professionals who prescribe opioids, that unlawfully divert of dispense prescription opioids for illegitimate purposes.
A criminal 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.
Additional documents related to the national announcement are available here: https://www.justice.gov/opa/documents-and-resources-june-28-2018.