In The News

The Department of Justice and Health and Human Services Recover $2.6 Billion as part of its Ongoing Campaign Against Healthcare Fraud

There is little doubt that the government’s efforts at combating healthcare fraud have been a success. This success has been demonstrated in terms of human health and safety and in terms of monies recovered by the government. As an example of the latter, the Health and Human Services Secretary Alex Azar released a fiscal year 2017 Health Care Fraud and Abuse Control report showing that the government has recovered $4 for every one dollar it has expended in its fight against healthcare fraud. In FY 2017, the government’s healthcare fraud prevention and enforcement efforts recovered $2.6 billion in taxpayer dollars from individuals and entities attempting to defraud the federal government and Medicare and Medicaid beneficiaries. Some of these fraudulent practices include:

  • The operation of “pill mills” from medical offices
  • Providers submitting false claims to Medicare for ambulance transportation services
  • Clinics submitting false claims to Medicare and Medicaid for physical and occupational therapy
  • Drug companies taking kickbacks from providers for prescription drugs
  • Companies misrepresenting the capabilities of their electronic health record software to customers

“Today’s report highlights the success of HHS and DOJ’s joint fraud-fighting efforts,” said HHS Secretary Azar. “By holding individuals and entities accountable for defrauding our federal health programs, we are protecting the programs’ beneficiaries, safeguarding billions in taxpayer dollars, and, in the case of pill mills, helping stem the tide of our nation’s opioid epidemic.” The Fraud Strike Force has secured prison sentences for more than 300 defendants, caused other defendants to enter Corporate Integrity Agreements (CIAs), and recovered vast sums of tax payer money. Lately, the current attorney general – Jeff Sessions – has included the national opioid crisis as part of the overall effort to combat healthcare fraud and abuse. Thus, the Department of Justice has also been going after doctors who overprescribe opioids. Of course people who are accused of defrauding the government are entitled to legal representation as are people who report such fraud. The latter can employ the services of a qui tam attorney. A qui tam law firm provides legal representation for individuals who, using the qui tam provisions of the False Claims Act, choose to sue on behalf of the government.


In addition to criminal prosecutions, the HHS Office of the Inspector General (OIG) has sought to exclude providers who have committed fraud from participation in healthcare programs in the future. A total of 3,244 individuals and entities were excluded in FY 2017. Some have even lost their licenses due to their alleged activities. In August of last year, Attorney General Sessions announced the formation of the Opioid Fraud and Abuse Detection Unit as part of the ongoing battle to combat healthcare fraud and abuse. Prosecutors have already charged several entities with the unlawful distribution of opioids.