The least you need to know about the federal takedown

On Thursday, federal agencies announced their largest ever healthcare fraud enforcement action. According to the U.S. attorney general’s office, 601 defendants were charged for alleged fraud totaling an estimated $2 billion. Here’s the least you need to know.

The takedown is significant.  Attorney General Jeff Sessions specifically pointed out that 162 medical professionals were charged for actions related to addiction treatment and narcotic diversion schemes. One of the physicians arrested is suspected of distributing 2.2 million unnecessary doses of painkillers, according to remarks from Sessions.

Keep in mind the federal task force responsible for the takedown is focused on Medicare and Medicaid fraud specifically, but it cooperates with the private payer community regularly to chase down bad operators. Thursday’s sweep also included 1,000 law enforcement officers.

In several of the cases, patient recruiters, health plan enrollees and others allegedly received kickbacks in return for coughing up insurance cards that eventually were used to file fraudulent claims with the Medicare program, according to the announcement. And arrests were made nationwide.

For example, four people involved with a sober living facility in Florida were charged with multiple offenses, and the indictment alleges patient brokering, paid kickbacks and widespread use of fraudulent urine testing. The facility submitted more than $106 million in claims for addiction treatment services. In all, 124 people in South Florida and 13 people in the middle district of the state were charged by federal authorities.

According to Sessions, 2017 brought indictments of more than 6,500 defendants in opioid-related investigations and seizures of more than $150 million.

However, it’s also important to note that some in the industry believe Sessions has been heavy-handed in driving investigations, causing reputable organizations to be hit with federal raids that interrupt patient care and put protected patient health information at risk—with no charges filed.