The Department of Justice (DOJ) has announced criminal charges against 78 individuals across 16 states for their involvement in alleged health care fraud and opioid abuse schemes. The charges, amounting to $7.8 billion in total, include $2.5 billion in alleged fraudulent claims.
The DOJ revealed that vulnerable groups such as the elderly, disabled individuals, and HIV patients were targeted in these schemes. Medicare, state Medicaid programs, and private insurers’ supplemental Medicare insurance programs were affected by the fraudulent claims.
Of the $2.5 billion in alleged fraudulent claims, approximately $1.1 billion was paid out. As part of the enforcement actions, the DOJ has seized or restrained millions of dollars in cash, vehicles, and real estate.
Attorney General Merrick Garland referred to this operation as one of the largest health care fraud schemes ever prosecuted by the Justice Department. He emphasized the department’s commitment to apprehending criminals who defraud the American public and steal from taxpayer-funded programs.
The charges, which were filed or unsealed between June 12 and June 28, involve a series of cases with similar fraudulent schemes. One of the cases involves an online platform called DMERx, which was implicated in a scheme that resulted in $1.9 billion worth of fraudulent claims to Medicare and other government insurers.
According to the case, DMERx targeted elderly and disabled Americans, convincing them to purchase unnecessary medical equipment and prescriptions. The platform would collect information from these individuals and generate fake doctors’ orders and prescriptions. Actual physicians were then paid by purported telemedicine companies to sign these fraudulent orders and prescriptions.
Another case involves a licensed physician named David Antonio Becerril from Washington state. Becerril allegedly signed over 2,800 fraudulent orders for orthotic braces, including ankle braces for a patient whose leg had been amputated years prior. Becerril spent less than 40 seconds reviewing and signing each fraudulent order.
The charges also include 10 individuals accused of collectively submitting over $370 million in fraudulent claims relating to prescription drugs. In one case, a pharmaceutical wholesale distribution company facilitated a $150 million fraud scheme. The owner of Scripts Wholesale Inc., Steven Diamantstein, is alleged to have illegally diverted prescription HIV medication and resold it after making it appear legitimate.
Pharmacies would purchase these misbranded medications, dispense them to patients, and bill health care benefit programs while the wholesale distribution company profited illegally, according to the DOJ.
Diamantstein’s defense attorney, Zach Intrater, stated that Diamantstein has pleaded not guilty and looks forward to contesting the charges in court.
In total, the charges against the 78 individuals account for over $150 million in fraudulent claims related to other forms of health care fraud. The DOJ has also identified 24 doctors and medical professionals who allegedly lined their own pockets. Some of them are accused of illegally prescribing opioids to patients who did not require them.
Several cases also involve healthcare companies and providers paying cash to obtain patient information from recruiters and beneficiaries. This enabled the providers to submit fraudulent claims to Medicare.
These charges highlight the ongoing battle against health care fraud and the illegal opioid trade in the United States. They serve as a reminder of the importance of law enforcement efforts to protect vulnerable populations and preserve taxpayer-funded programs.
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