WASHINGTON — Federal agencies on Thursday announced charges in what Attorney General Jeff Sessions called “the largest health care fraud takedown in American history,” an investigation into over $2 billion in alleged fraud by doctors, pharmacists, and nurses.

Many of the allegations centered on illegitimate opioid prescriptions. The Justice Department charged 162 defendants, including 76 doctors, for their roles dispensing opioids and narcotics, the result of investigations spanning 30 state Medicaid programs and numerous enforcement agencies.

One set of charges in Florida details what prosecutors described as $106 million in fraudulent claims for substance abuse treatment in a scheme that involved “widespread fraudulent urine testing.” Another in Texas alleges that a pharmacy owner and pharmacist conspired to fill orders for over 1 million opioid doses, which were then sold to “drug couriers” for millions of dollars.

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“Some of our most trusted medical officials, professionals, look at their patients, vulnerable people suffering from addiction, and they see dollar signs,” Sessions said.

The alleged fraud and false billings collectively accounted for 13 million illegal opioid dosages, the Justice Department said, and also included 23 pharmacists and 19 nurses.

The Department of Health and Human Services also announced that since July 2017, it has excluded over 2,700 individuals and 587 providers from Medicare and Medicaid “for conduct related to opioid diversion and abuse” — including 67 doctors, 402 nurses, and 40 pharmacy services.

Already, Sessions said, enforcement has resulted in lower billing levels in some government health programs, with billings for Medicare Part A and Part B — which cover inpatient care and many physician-prescribed drugs, respectively — dropping by 20 percent in districts with fraud strike forces.

“One doctor allegedly defrauded Medicare of more than $112 million by distributing 2.2 million unnecessary dosages of drugs like oxycodone and Fentanyl,” Sessions said. “Thirteen defendants allegedly defrauded taxpayers of more than $126 million, much of which was intended to pay for health care for our troops. These are despicable crimes.”

Drug distributors have been a focus on Capitol Hill and at the White House during the Trump administration. In May, lawmakers took distributor executives to task for what they said was a lack of due diligence on large opioid orders from pharmacies. Separately, dozens of distributors and drug manufacturers are facing charges from cities, states, counties, and Native American tribes in a consolidated case in an Ohio federal court that could yield an unprecedented settlement.

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Without alleging criminal activity by patients, the report also identified nearly a half-million Medicare beneficiaries said to be receiving regular opioid dosages since 2016 that exceed prescribing guidelines issued by the Centers for Disease Control and Prevention.

That data, HHS Deputy Inspector General Gary Cantrell said, had enabled the agency to identify 300 prescribers “whose questionable opioid prescribing is worthy of further investigation.”

The Centers for Medicare and Medicaid Services has recently attempted to cap the vast majority of opioid doses at 90 morphine milligram equivalents, but an increasingly vocal advocacy network of chronic pain patients forced the agency to preserve much of the flexibility in its own rules.

John Martin, a DEA assistant administrator, said he did not believe prescription opioids were becoming over-regulated, thereby risking an escalation to more dangerous drugs like heroin and fentanyl for patients having trouble obtaining a legitimate opioid prescription.

“It is not that we are over-regulating, but doctors and medical practitioners are more aware,” he said. “There are a lot of people addicted to opioids and sometimes it is easier to get street drugs.”

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  • Looking at the entirely un-useable numbers that constitute reports on causes of death in the U.S., collected by 2342 different offices, which collect data on different drugs in different jurisdictions, or in the same jurisdiction in different years, in which very few Americans are autopsied, 2/3 of death investigators have no in house toxicology lab, 2/3 have no in house histology lab. 1/3 no in house x-ray, 2/3 of Americans served by not medical examiners but elected coroners (often required to have no medical or science credentials), the claims of opiate deaths going up or down or remaining stable would be impossible to confirm.

    I suspect that after the government created enormous red-tape surrounding the sale of Sudafed in the name of fighting illegal meth (which remains legal, although where I live it’s easier to get a gun than Sudafed), Americans’ attention had to be diverted before we noticed what a boondoggle the restrict-legal-medications-to-fight-meth operation was. So they went, “Quick, look over there – opiates are bad!”

    • You hit the nail on the head there. There are no standard reporting requirements either. Prescriptions are no longer a problem, most states have taken drastic measures, and taken away opiates for people with serious chronic pain conditions. People are so afraid of opiates they are refusing to take them even when they are dying of cancer.
      Our DOJ is merely grandstanding, they still refuse to prosecute the Sackler Family, or the corporations that Illegally diverted Opiates on an industrial scale. Many of these “Overdoses” are due to other drugs including the pharmaceuticals that were marketed as alternatives. Counting these deaths could cut into pharma profits.
      They are now going after disabled and sick Americans, who take prescribed opiates for injuries, cancer, and crippling musculo skeltal injuries.
      We have an Administration that believes in Alternative Facts. CMS is already collecting data on any over prescribers. They will probably use the Fact that there are much fewer prescribers, fewer physicians treating pain, and pain patients traveling hundreds of miles for treatment to the few remianing prescribers to misrepresent the facts.
      They will do anything to avoid tackling the real problem, the corporations, they failed to regualte. More people are dying from Heroin, so instead of dealing with that, they are going after the few remaining prescribers and vulerable patients.

    • Mavis Johnson
      Thank! You make many good points too!

      I would only add that l don’t see anyone from either party publicly challenging the plight of law abiding pain patients or Prohibition 2.0 (the drug war is literally that – when alcohol ban was lifted the Bureau of Investigations/FBI immediately pivoted to drugs to keep their jobs)

      We need to make sure more people see the inhumanity of punishing – and unjustly terrifying – pain patients in the service of changing bahavior of criminals (by sympathetic magic? Certainly not logic. Supermax regularly drug test inmates & get some testing + every time). We must use everything at our disposal to call attention to the absurd cruelty of taking out the predictable failure of drug prohibition on sick and injured people.

      Here’s a website challenging drug wat narratives:
      truth0rDARE.com (the 0 is a zero, if you need to type it manually)

    • We won’t see anyone speaking up either, they are in the pocket of the industries that are profiting here. Pain patients are a convenient scapegoat, and they represent injured workers, Veterans, and people the administrations has already stated they would like to get rid of. The media has been silent too. They are owned by Pharma, and have to craft careful and deceptive false narrative.
      I have been tracking this topic for over 20 years, and there has been no improvement. The media demonized pain patients, remember “Hillbilly Heroin.” Psychologists rewrote the DSMV5, which is only useful of billing. They deliberately conflated chronic pain and addiction. The numbers they repeatedly roll out are misleading and deceptive. Each and every mass media article uses the numbers with no explanation. They never explain how the reporting requirements are loose for a reason. Up to a quarter of the deaths attributed to overdose are due to other legal pharmaceuticals, which the industry marketed for everything, including addiction. Those other drugs are profitable. The fear based marketing is profitable too, peddling everything from dangerous medical devices, useless alternative cures, and dangerous drugs.
      The last thing our administration is going to do is look at facts and data, that might interfere with profits. Our government failed to protect any of us, just like they failed to regualte the tech companies, that spread misinformation. They failed to prosecute the big pharmaceutical that profited, and undermined the DEA’s Law Enforcement years ago. The media keeps repeating false news, leaving out the fact that opiates are barely available for surgeries or cancer patients. Most states cracked down several years ago, yet that is not sensational enough to get reader attention. They decided that looking at the actual data and facts is inconvenient.
      There has been a lot of pain patient commentary on the New York Times Articles, and there are Pharma Funded Groups, like the National Pain Report, where pain patients weigh in. There has been a deliberate attack on pain patients, and the groups on Facebook, have been used to harvest data, to create a false narrative, to undermine them.

    • Mavis, I could not agree more that no one in either party is in any hurry to stick up for us. Unlike the addiction community, who can get a big bunch of people out in front of he press with events like the Portland Oregon/Vancouver Washington hands-across-the-river event, pain patients deprived of drugs stay home on the couch alone and cry.

      On top of that, drug prohibition is a cancer on our government. I have counted about 35 federal agencies and/or departments dedicated to drug war &/or 12 steps promotion. I read that Alexander Cockburn found at least 50 some years ago (his number is probably right. I probably need to come up with some more search terms to close the gap between his numbers and mine). That’s an awful lot of people who would have to get a real job if drug prohibition went the way of alcohol prohibition.

      Meanwhile, we need to make whatever noise we have the capacity to make, and connect with as many other people and resources as possible. I just found this excellent website last night: http://www.drugwarrant.com

      One other thing I am thinking is that the law-abiding pain patient community might have to start making a firm dividing line between us and the addiction rehab industry and community. I see plenty of stories where people put the blame for their addiction – and the bad behavior they blame on addiction – on a legitimate prescription, supporting the prescriptions-fuel-the-black market narrative. And worse, not only do criminals tell drugs-made-me-commit crime narratives, but the justice system plays along. Even inmates whose crimes have nothing to do with drugs can get perks and rewards in prison if they sign up for 12 steps groups in the prison. And drug courts are selling to people with drug arrests the idea that going to “treatment” is preferable to prison (which it probably is) and sweeten the deal with a promise of an expunged record, creating a situation in which someone who actually doesn’t have any of the antisocial characteristics we associate with addiction, will be put into a position to claim to suffer addiction, just to avoid the draconian punishments they would otherwise suffer.

      But one other thing, which I haven’t yet figured out how to even start to do, is to figure out how to get through to so many people who call themselves libertarians but buy every bs narrative the government has ever generated about drugs (sometimes with the exception of marijuana). I’m flummoxed that people who are so suspicious of the government that they resist the idea it can do anything well will spew false claims about drugs that the government generated.

  • What we have witnessed within the past few years is excessive government restrictions and bans, along with government interference, have all only aggravated this entire situation, including increasing overdose rates due to sending so many people to the unregulated substances offered by the black market.

    No government (esp a government over a supposedly “free” country) should ever be allowed to dictate and/or restrict health care, particularly when it comes to one’s pain and suffering (unless it is to help its citizens obtain proper medical attention).

    The US (and states’) government(s), along with insurance companies, (both filled with individuals who have no medical training or license to practice medicine) are now dictating who deserves pain relief and who doesn’t, usually by diagnosis (which can often be wrong)

    Rationing pain-relieving medications (DEA quota system), excessive restrictive regulations, and government interference is simply making things worse. (They haven’t gotten the message that prohibition has never worked).

    The opioid prescribing rates have peaked (2011 or 2012??) then decreased greatly within the past few years, however alcohol use/abuse rates, illicit drug use/abuse rates, overdose death rates and suicide rates have all skyrocketed. What does that tell you?

    Also, government restrictions are only increasing the profits for drug cartels, who are also responsible for henious crimes like human and sex trafficking. The cartels are thriving greatly due to this government-waged “war,” which has become a government-waged war on vulnerable, chronically-ill and disabled people.

    Historians all agree that substance abuse and addiction rates have remained relatively the same among all societies throughout history. Why? Because where there are humans, there is always a small portion of those who – for whatever reason – feel the need to self-medicate.

    Furthermore, where there are government restrictions and bans on mind-altering substances, there is always a small portion of society willing to offer those substances (or chemically-related substances) for a price.

    The DEA has reduced the production quota of CS II opioid medications by up to 45% within the past three years. What have we witnessed due to this? Increased supply of chemically-related substances with unregulated “purities” and God-only-knows-what-kind-of-fillers within those substances. This has increased overdoses and overdose death rates by a huge percentage.

    The availability of substances and even moderate consumption does not “cause” addiction. The history on the availability of alcohol has shown us that. Most adult Americans have consumed a small amount of alcohol at least once in their lives, however, just a small portion end up abusing it, which risks addiction to it.

    The substance of abuse and addiction is merely the main symptom of a complex (often chronic) mental health disorder known as addiction, which is usually associated with underlying issues different to each addict.

    Untreated or undertreated mental health illnesses and disorders, poverty and hopelessness, past or present traumas (sexual abuse, emotional and/or physical abuse), poor emotional support, and just the need to self-medicate emotional pain are all major contributors to substance abuse and/or addiction.

    Governments can’t regulate nor should they ever be allowed to dictate the way a person treats their own body along with who deserves pain relief and who doesn’t.

    History has shown us over and over again that excessive restrictions and bans on substances simply do not work and even aggravates the rates of abuse and addiction.

    • Amen Tracey,,,there are laws ,this regime are breaking everyday!!,The government is not allowed to practice medicine,,,its against the law..They are not viewing our medicine as a medicine and it is!!!They have violated every law that has founded this country thru their abuse of power..Even them stating these new laws as law,,,is against the law..Its called abusing your power ,”under the color of law,” which is illegal,,Sooo tell us why,,,no attornery’s,,,yet,,,will help us??maryw

    • Brava Tracey! I have access to charts and graphs and white papers that all day the same thing: it was never about prescription medications, as prescription rates had been falling on their own anyway. But by persecuting pain patients, they get patients off the opiates that they no longer make money on and take advantage of patients desperate for some kind of relief by pushing dangerous injections, surgeries, and stim units that often cause far more problems but make them a whole lot more money.

      And you’re right Mary – where are the lawyers? One would think that ambulance chasers would be picking up these cases left and right… but patients are told there is nothing they can do for us. Why? Have there not been enough patients suffering and dying, or is there some kind of unknown quota that needs to be filled before someone finally helps us?

      He may not be a lawyer, but look up Robert Rose… He’s a Veteran fighting not only for other Vets that have been kicked off their meds, but for those of us that have been harmed by the CDC as well. He has a hearing coming up July 17th in front of a federal judge in TN, and we need people to write to the judge, testify, and just plain show up and pack that courtroom! I know this link is to a GoFundMe page, but it has all the contact information. Please, email, text, or call this Marine who is still fighting for this country. Thank you.
      https://www.gofundme.com/fedcivil-tort-vs-mountain-home-vamc

  • Thats because our buddy klonadyn whilst in the cdc changed the definition of addiction from;Taking any medicine for non-medical purposes,,,tooo Addiction =taking anything that causes harm,,,,,sooo they can now trump,lie on allll addiction daa,,,understand?It needs to be changed back asap,,maryw

    • That is how they did it. The Psychologists re-framed it too, in their DSMV. Probably to help Pharma with more prescribing opportunities, and to discredit people with Chronic Pain. They had to come up with a cover story for the Epidemic of Despair, and make all of those medical mistakes go away. The misguided attempts to curb this so called “Epidemic” have more bodies piling up, and at the same time the Industries profiting from this, don’t want the actual COD counted. they underfunded Coroners Offices, and removed Reporting Requirements.

  • I lost my doctor of 17+ years to this BS this past week. I’ve been prescribed the same medications for all of those 17 years. I suffered Traumatic Brain Injury in 1991 and spent 11 years before 2002 trying acupuncture, hypnosis, physical therapy, deep-tissue massage and dozens of medications written “off-label” for head pain, like antidepressants, antiseizures, blood pressure and migraine meds. Every migraine med ever made! Nothing worked and I was ready to end it all. Then I found my certified Pain Management Specialist and got relief for the first time. 17 years of at least some relief. Now what? Go back to where I was before? I can’t live in that kind of pain again. But does our government care? Of course they don’t. They haven’t been able to stop synthetic fentanyl for a minimum of 13 years and they can’t do anything about it now that the cartels are involved. DEA says they stopped cocaine and methamphetamines. Has anyone seen the statistics concerning these drugs over the last several years? DEA and CDC colluded to make pain meds an issue to distract from their failure to stop synthetic fentanyl. And the media and our ignorant federal government fell for it. How many people like me will be alive in 2-3 years? 5 years? A lot less, that’s for sure. Thanks, Elmer Fudd, er, Jeff Sessions. And has there ever been such a misnomer as “Health and Human Services”? I HATE all politicians, Republicans AND Democrats. They all SUCK!

  • His response to chronic pain patients having difficulty receiving the care and meds they need is “It’s not that we are over regulating”…”it’s that there are a lot of people addicted to opiods…” ? He flat out called chronic pain sufferers addicts. I wish he was sentenced for just 24 hours inside of my body. I suffer with Elhers-Danlos, Trigeminal Neuralgia (nicknamed the suicide disease) and Occipital Neuralgia. He’d spend the day crying and unable to eat or sleep. This man is completely tone deaf, ignorant, and inconsiderate.

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