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193 People Charged Over National Healthcare Frauds

"The Justice Department will bring to justice criminals who defraud Americans, steal from taxpayer-funded programs, and put people in danger for the sake of profits."

FBI Director Christopher Wray added: "Healthcare fraud victimizes patients, endangers the health of vulnerable people, and plunders healthcare programs."

“This wide-ranging collaboration demonstrates the FBI’s commitment to rooting out predatory healthcare fraud, protecting patients, and ensuring critical healthcare funds go where they are needed most.”

The charges include:

• A $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
• A $90 million fraud committed by corporate executives distributing adulterated and misbranded HIV medication
• $146 million in fraudulent addiction treatment schemes
• Over $1.1 billion in telemedicine and laboratory fraud
• $450 million in other healthcare fraud and opioid schemes.

The 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 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.

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Amniotic Wound Grafts

Charges were filed in the District of Arizona against four people who allegedly filed $900 million in false and fraudulent claims to Medicare for amniotic wound grafts used on Medicare patients.

It is alleged, the defendants targeted elderly Medicare patients, many of whom were terminally ill.

They are accused of causing medically unnecessary and expensive amniotic grafts to be applied to these vulnerable patients’ wounds indiscriminately.

They are also accused of giving treatment without coordination with the patients’ physicians and without proper treatment for infection.

It is also claimed the treatments were made to wounds that did not need it, and in sizes that larger than the size of the wound.

In just 16 months, Medicare paid two defendants more than $600 million as a result of their fraud scheme.

It paid out more than a million dollars per patient for these unnecessary grafts.

These two defendants owned wound care companies in Arizona.

They 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. were charged for the unlawful distribution of millions of Adderall pills.

The CEO and Clinical President of Done were charged on June 13 over a scheme to distribute Adderall and other stimulants over the internet.

More charges include those against one of the most prolific prescribers working for Done.

This is a Florida nurse practitioner who is alleged to have prescribed over 1.5 million pills of Adderall and other stimulants to patients across the United States.

The indictment alleges they 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.

They were allowed to carry on getting the medication 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.

They are also alleged to have continued 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.

It is alleged this was to introduce adulterated and misbranded HIV drugs into the market.

The drugs were allegedly acquired through unlawful “buyback” schemes.

They allegedly came from previously dispensed bottles of prescription drugs were bought from vulnerable patients.

The defendants allegedly purchased these drugs from the black market.

They then resold them to pharmacies throughout the country.

They are said to have provided falsified documentation designed to conceal the true source of the medication.

Pharmacies then dispensed these medications to unsuspecting patients. 

At times, patients received bottles labeled as their prescription medication, but the bottles contained a different drug entirely.

One man passed out and was unconscious for 24 hours after taking an anti-psychotic drug thinking it was his prescribed HIV medication.

Addiction Treatment Cases

The addiction treatment cases announced include charges filed in the District of Arizona and Southern District of Florida.

These are against four defendants.

The charges are in connection with more than $146 million of false and fraudulent claims for services for vulnerable patients.

These are people having treatment for drug or alcohol addiction.

The indictments allege one defendant paid kickbacks in exchange for the referral of homeless patients and those from Native American reservations.

She then fraudulently billed Arizona Medicaid for substance abuse treatment services that were either never provided or that were so bad they failed to serve any treatment purpose.

The defendant is charged with money laundering offenses for her lavish purchases with the fraud proceeds,.

She is also charged with obstruction of justice.

She is accused of allegedly falsifying records in response to a grand jury subpoena for documents.

Telemedicine and Laboratory Fraud Cases

36 defendants were charged in connection with the submission of over $1.1 billion in fraudulent claims to Medicare resulting from telemedicine schemes.

Criminal networks across the country are accused of paying illegal kickbacks and bribes.

These are 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 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.

These are said to include visits that lasted between 10 to 30 seconds.

Cases Involving the Illegal Prescription and Distribution of Opioids and Other Healthcare Fraud Schemes

Other cases announced see 14 defendants charged with crimes related to the illegal prescription and distribution of opioids that resulted in millions in false billings.

This includes several charges against medical professionals and others who prescribed unnecessary opioids, Suboxone, and other controlled substances.

126 additional charges

An additional 126 defendants are charged with various other healthcare fraud schemes;.

These revolve around $450 million in false and fraudulent claims to Medicare, Medicaid, and private insurance companies for treatments that were medically unnecessary or never provided.

10 defendants across the country were also charged in connection with fraudulent COVID-19 testing.

This includes an over $65 million scheme charged in the Southern District of Florida.

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