ASHINGTON — 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.
“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.
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.”