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Justice Department accuses 138 medical professionals of $1.4B in fraud

Sept. 17 (UPI) -- The Justice Department on Friday charged 138 medical professionals for allegedly taking part in healthcare fraud totaling some $1.4 billion.

The government said the defendants, which included doctors and nurses, used a number of schemes to target "the vulnerable in our communities."

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"This nationwide enforcement action demonstrates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain," said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department's Criminal Division.

"The charges announced today send a clear deterrent message and should leave no doubt about the department's ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a continued pandemic."

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The largest of these were cases in which professionals across 11 judicial districts used telemedicine to defraud victims of about $1.1 billion.

They allegedly paid doctors and nurses to order unnecessary medical equipment, medical testing and pain medications for patients they'd either never seen or spoke with only briefly over telephone. The Justice Department said durable medical equipment companies, testing laboratories and pharmacies then purchased these orders in exchange for kickbacks and submitted the claims to Medicare and other government insurers.

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The government said the proceeds of the fraud were spent on luxury items including vehicles, yachts and real estate.

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Some of the accused also allegedly submitted more than $29 million in false billings related to the COVID-19 pandemic. The Justice Department said healthcare professionals exploited special policies put in place by the Centers for Medicare & Medicaid Services to make it easier for patients to receive care during the pandemic.

The defendants allegedly submitted claims for medically unnecessary testing and misused CARES Act funding for their own personal expenses.

Other schemes were tied to the opioid crisis, including more than $133 million in allegedly false and fraudulent claims for tests and treatments of patients seeking treatment in sober homes.

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The Justice Department also charged professionals for illegally prescribing and distributing opioids and other prescription narcotics, resulting in more than $14 million in false billings.

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