In connection with the coordinated nationwide law enforcement action, and together with federal and state law enforcement partners, the government seized over $231 million in cash, luxury vehicles, gold, and other assets.
The charges alleged include over $900 million fraud scheme committed in connection with amniotic wound grafts; the unlawful distribution of millions of pills of Adderall and other stimulants by five defendants associated with a digital technology company; an over $90 million fraud committed by corporate executives distributing adulterated and misbranded HIV medication; over $146 million in fraudulent addiction treatment schemes; over $1.1 billion in telemedicine and laboratory fraud; and over $450 million in other health care fraud and opioid schemes.
This enforcement action was led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section and its core partners: U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI, and Drug Enforcement Administration (DEA). The cases were investigated by agents from the division’s core partner agencies along with other federal and state law enforcement agencies. The cases are being prosecuted by Health Care Fraud Strike Force teams from the Criminal Division’s Fraud Section, 32 U.S. Attorneys’ Offices nationwide, and 11 State Attorney Generals’ Offices.
Amniotic Wound Grafts
Charges were filed in the District of Arizona against four individuals who allegedly filed $900 million in false and fraudulent claims to Medicare for amniotic wound grafts used on Medicare patients. As alleged, the defendants targeted elderly Medicare patients, many of whom were terminally ill. The defendants caused medically unnecessary and expensive amniotic grafts to be applied to these vulnerable patients’ wounds indiscriminately, without coordination with the patients’ treating physicians and without proper treatment for infection, to superficial wounds that did not need this treatment, and in sizes that far exceeded the size of the wound. In just 16 months, Medicare paid two defendants more than $600 million as a result of their fraud scheme, paying on average more than a million dollars per patient for these unnecessary grafts. These two defendants owned wound care companies in Arizona and received more than $330 million in illegal kickbacks in exchange for purchasing the grafts billed to Medicare. In connection with the charges, the government seized over $70 million, including four luxury vehicles, gold, jewelry, and cash.
Distribution of Adderall and Other Stimulants
Five additional defendants associated with digital technology company Done Global Inc. and its affiliated entity, Done Health P.C. (collectively, “Done”), were charged for the unlawful distribution of millions of Adderall pills. The CEO and Clinical President of Done were charged on June 13 in a scheme to distribute Adderall and other stimulants over the internet. The charges include those against one of the most prolific prescribers working for Done, a Florida nurse practitioner who prescribed over 1.5 million pills of Adderall and other stimulants to patients across the United States. The indictment alleges that the nurse practitioner prescribed Adderall and other stimulants without interaction with patients, pursuant to Done’s “auto-refill” policy. This policy allowed patients to obtain continued prescriptions after an initial encounter without any further audio or visual interaction with a medical professional. This allegedly resulted in the nurse practitioner prescribing Adderall and other stimulants to individuals suffering from drug addiction and continuing to issue Adderall prescriptions for months after the overdose deaths of patients.
Diverted HIV Medication
Three owners and executives of a wholesale distributor of pharmaceutical drugs were charged in connection with an alleged $90 million wire fraud conspiracy to introduce adulterated and misbranded HIV drugs into the market. The HIV drugs were allegedly acquired through unlawful “buyback” schemes in which previously dispensed bottles of prescription drugs were bought from vulnerable patients. The defendants allegedly purchased these drugs from the black market and resold them to pharmacies throughout the country with falsified documentation designed to conceal the true source of the medication. Pharmacies then dispensed these diverted HIV medications to unsuspecting patients. At times, patients received bottles labeled as their prescription medication, but the bottles contained a different drug entirely, with one patient passing out and remaining unconscious for 24 hours after taking an anti-psychotic drug thinking it was his prescribed HIV medication.
Addiction Treatment Cases
The addiction treatment cases include charges filed in the District of Arizona and Southern District of Florida against four defendants in connection with more than $146 million of allegedly false and fraudulent claims for services for vulnerable patients seeking treatment for drug or alcohol addiction. As alleged in one of the indictments, one defendant paid kickbacks in exchange for the referral of patients recruited from the homeless population and Native American reservations. She then fraudulently billed Arizona Medicaid for substance abuse treatment services that were either never provided or were provided at a level that was so substandard that it failed to serve any treatment purpose. The defendant is charged with money laundering offenses for her lavish purchases with the fraud proceeds, as well as obstruction of justice for allegedly falsifying records in response to a grand jury subpoena for documents.
Telemedicine and Laboratory Fraud Cases
Thirty-six defendants were charged in connection with the submission of over $1.1 billion in fraudulent claims to Medicare resulting from telemedicine schemes. For example, in separate cases involving similar schemes that were perpetrated by different criminal networks in the Southern District of Texas, Northern District of Texas, and District of New Jersey, clinical laboratory owners allegedly paid illegal kickbacks and bribes, including to telemedicine companies, in exchange for the referral of orders for unnecessary genetic testing. The results of these genetic tests—which were supposed to detect genetic mutations that could indicate an elevated risk of cancer, cardiovascular disease, Parkinson’s disease, and other serious illness—were not used in the patients’ treatment. Other telemedicine schemes included the unsealing of a complaint in the Eastern District of Virginia against a psychiatrist who allegedly submitted fraudulent claims based on minimal patient interactions, including for visits that lasted between 10 to 30 seconds. The continued focus on prosecuting health care fraud schemes involving telemedicine reflects the Department’s commitment to rooting out these schemes, which has saved taxpayers billions of dollars.
Cases Involving the Illegal Prescription and Distribution of Opioids and Other Health Care Fraud Schemes
The other cases announced June 27 charge 14 defendants with crimes related to the illegal prescription and distribution of opioids that resulted in millions in false billings, including several charges against medical professionals and others who prescribed unnecessary opioids, Suboxone, and other controlled substances.
An additional 126 defendants are charged with various other health care fraud schemes involving over $450 million in false and fraudulent claims to Medicare, Medicaid, and private insurance companies for treatments that were medically unnecessary or never provided. Ten defendants across the country were charged in connection with fraudulent COVID-19 testing, including an over $65 million scheme charged in the Southern District of Florida.
The Center for Program Integrity of the Centers for Medicare and Medicaid Services (CPI/CMS) separately announced that it took adverse administrative actions in the last six months against 127 medical providers for their alleged involvement in health care fraud.