DOJ announces alleged $1.8B healthcare fraud bust

The U.S. Department of Justice on Thursday announced charges against 15 defendants, including six medical professionals, for what it described as $1.8 billion worth of fraudulent healthcare claims. Authorities arrested eight defendants in Los Angeles, Dallas, and Chicago on Thursday morning, with 10 total arrests so far. The case includes the largest sober home fraud scheme ever prosecuted by the Department of Justice, according to the agency.

Colin McDonald, Assistant Attorney General for the department’s National Fraud Enforcement Division, announced that the fraudulent healthcare claims included fake substance abuse treatment, unnecessary surgical procedures, and fake hospice services.

What were the specific fraudulent claims? The alleged fraud includes more than $1.6 billion in billings tied to a scheme the Justice Department said lured individuals into California for sham substance abuse treatment. It also includes $134 million in fraudulent Medicare billings for medically unnecessary atherectomies, surgical procedures that involve a bladed catheter used to clear plaque from arteries. Those procedures resulted in patient injuries, Justice officials said. The department blamed another $138 million in fraudulent Medicare billings on three hospice schemes involving patients who were not terminally ill. Two California doctors also allegedly received illegal kickback for authorizing millions of dollars in unnecessary genetic tests.