DISTRICT OF COLUMBIA — Two Utah defendants in separate cases were charged as part of the largest health care fraud enforcement action in U.S. history, according to federal officials.
Attorney General Jeff Sessions and Department of Health and Human Services Secretary Alex M. Azar III announced in a press release the largest-ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts including 165 doctors, nurses and other licensed medical professionals for their alleged participation in health care fraud schemes involving more than $2 billion in false billings. One case involved a $31 million scheme to defraud Medicare and Medicaid.
Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also assisted in the arrests.
HHS also announced that from July 2017 to present, it has excluded 2,700 individuals from participation in Medicare, Medicaid and all other federal health care programs, including 587 providers excluded for conduct related to opioid diversion and abuse.
In Salt Lake City, federal prosecutors filed a one-count misdemeanor information June 26 charging Living for Life MD, doing business as SLC Med Spa, with receipt and delivery of adulterated devices. They allege that the Salt Lake City business imported drugs not approved by the Food and Drug Administration from an unauthorized distributor and administered them to patients. The foreign-sourced devices, specifically products labeled as Juvederm Ultra 2, were adulterated and lacked pre-market approval required under federal law.
“We take these health care cases very seriously in Utah,” U.S. Attorney John W. Huber said in the press release. “Patients must be able to rely on their doctors to provide them with proper care and legitimate, FDA-approved drugs.”
The information includes a notice of intent to seek a forfeiture money judgment of $250,000, which represents the value of the misbranded devices.
In the second Utah case, a grand jury returned an indictment June 27 charging Colette Krum Kolesar, 48, of Spanish Fork, with one count of destruction, alteration or falsification of records in a federal investigation. Kolesar worked for a home health and hospice center with an office in Provo.
The indictment alleges the defendant altered medical records, including therapy notices from nursing visits, with the intent to impede, obstruct or influence an investigation by the HHS and the Centers for Medicare and Medicaid Services.
The potential maximum penalty is 20 years in prison and a fine of $250,000.
Nationally, the charges aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families) and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.
The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics.
“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” Sessions said in the press release. “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets. These are despicable crimes.”
He added that the action taken to prosecute those committing fraud is the largest in American history – the most fraud, most defendants and most doctors charged in an operation.
According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE and private insurance companies for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could then submit fraudulent bills to Medicare.
Collectively the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of submitting a total of over $2 billion in fraudulent billings. Virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims. Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.
“Healthcare fraud touches every corner of the United States and not only costs taxpayers money, but also can have deadly consequences,” Bowdich said in the press release. “Through investigations across the country, we have seen medical professionals putting greed above their patients’ well-being and trusted doctors fanning the flames of the opioid crisis.”
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in 10 locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.
A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law, the press release notes.