Nearly 200 people have been charged for their roles in various health care fraud schemes across the U.S. that federal authorities say amounted to over $2.7 billion in intended losses, the Justice Department announced on Thursday.
Attorney General Merrick Garland announced charges against 193 people, including 76 doctors, nurse practitioners, and other licensed medical professionals in 32 different federal districts. The defendants were charged over a two-week sweep involving numerous law enforcement agencies nationwide, resulting in the seizure of more than “$231 million in cash, luxury vehicles, gold, and other assets,” according to Garland.
“It does not matter if you are a trafficker in a drug cartel or a corporate executive or medical professional employed by a healthcare company if you profit from the unlawful distribution of controlled substances, you will be held accountable,” Garland said in a statement. “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.”
The defendants were accused of conducting a variety of schemes that involved millions of dollars in fraudulent claims, wire fraud, health care fraud, and money laundering, according to the Department of Justice. In Arizona, five cases were filed in federal court — including a $900 million scam that targeted elderly and terminally ill patients.
Earlier this month, federal authorities arrested and charged the founding CEO and clinical president of a major telehealth company. Prosecutors accused the company of illegally distributing pills of Adderall and other medicines. On Thursday, Garland said an additional five defendants were charged for allegedly participating in the scheme to distribute more than 40 million “medically unnecessary pills.”
In Florida, an over $90 million fraud scheme was committed by corporate executives who distributed adulterated and misbranded HIV drugs across the country, the Department of Justice said. Federal authorities also noted other scams that included targeting Native Americans with fraudulent sober living homes; illegally prescribing or distributing opioids; and medical professionals committing telemedicine and laboratory fraud.
In a separate announcement Thursday, the Center for Program Integrity of the Centers for Medicare and Medicaid Services said that it “took adverse administrative actions in the last six months against 127 medical providers for their alleged involvement in health care fraud,” according to the Department of Justice.
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Unnecessary amniotic grafts applied to ‘vulnerable patients’ wounds’
Four individuals were charged in Arizona for allegedly submitting $900 million in false and fraudulent claims for amniotic wound grafts that were used on elderly Medicare patients — “many of whom were terminally ill in hospice care,” according to the Department of Justice.
The victims were targeted through several wound care companies owned by Alexandra Gehrke, 38, and Jeffrey King, 49, court documents revealed. Gehrke and King were charged with various counts of conspiracy, health care fraud, receiving kickbacks, and money laundering.
Prosecutors alleged that two nurse practitioners were also involved in the scheme.
“The defendants caused unnecessary and extremely expensive amniotic grafts to be applied to these vulnerable patients’ wounds indiscriminately, without coordination with the patients’ treating physicians, without proper treatment for infection, to superficial wounds that did not need this treatment, and in sizes excessively larger than the wound,” according to the Department of Justice.
Court documents further alleged that King had pressured nurse practitioners to apply the grafts and that some patients had died the same day or within days after their graft application.
King and Gehrke received over $330 million in illegal kickbacks in exchange for buying grafts that were billed to Medicare, the Department of Justice said. As part of the investigation, federal authorities seized over $70 million, including four luxury vehicles, gold, jewelry, and cash.
Medicare has paid more than $1 million per patient due to the unnecessary grafts — totaling over $600 million in 16 months, according to the Department of Justice
Patient ‘unconscious for 24 hours’ after receiving misbranded drug
In Florida, three owners of a wholesale pharmaceutical company were accused of distributing adulterated and misbranded HIV drugs, the Justice Department said. Adam Brosius, 59; Patrick Boyd, 43; and Charles Boyd, 46, have been charged in connection to their alleged wire fraud scheme.
According to the indictment, the pharmaceutical company bought over $90 million of “heavily discounted and diverted” prescription drugs from five black-market suppliers. The three defendants then allegedly resold the drugs to pharmacies located across the country.
The drugs were distributed with falsified documentation that concealed the medication’s original sourcing, the indictment states. Pharmacies then dispensed the drugs to “unsuspecting patients,” according to the Department of Justice.
“As a result, patients at times received bottles labeled as their prescription medication with entirely different drugs inside,” Garland said. “One patient passed out and was unconscious for 24 hours after taking an anti-psychotic that he believed was his prescribed HIV medication.”
Homeless population, Native Americans targeted in treatment scheme
Four people were charged in Arizona and Florida for allegedly filing false and fraudulent claims for patients who were seeking treatment for drug or alcohol addiction, according to the Department of Justice. The schemes resulted in more than $146 million in false and fraudulent claims.
In one of the indictments, 52-year-old Rita Anagho was accused of paying kickbacks in exchange for the referral of vulnerable patients who were from the homeless population and Native American reservations. Anagho owned an outpatient treatment center in Arizona, which was enrolled as a provider in the state’s Medicaid agency.
The indictment alleged that Anagho 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,” the Department of Justice said.
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