HHS, DOJ crack down on $1.3B in healthcare fraud

A Nebraska dentist and two Michigan dentists were three of more than 400 people charged with healthcare fraud on July 13, 2017, by the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS). The defendants allegedly billed the U.S. government approximately $1.3 billion in fraudulent services.

The DOJ claimed the defendants billed Medicare, Medicaid, and veteran insurance program TRICARE for prescription drugs, medications, and services that were medically unnecessary or never provided. This was the largest action against healthcare fraud, according to the DOJ, and 115 licensed medical professionals were charged with fraudulent billings, including dentists in Omaha, NE; West Bloomfield, MI; and Camden, MI.

"Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients," stated Attorney General Jeff Sessions in a press release. "Amazingly, some have made their practices into multimillion dollar criminal enterprises."

Alleged Medicaid fraud

The July 13 charges were part of an annual effort to combat healthcare fraud called the Health Care Fraud Takedown. The event is coordinated by the DOJ and HHS, and this year's effort involved more than 1,000 state and federal law enforcement agencies.

The healthcare professionals charged with fraud include doctors, nurses, pharmacists, and at least three dentists in two states. A report on the website of KMTV in Omaha identified the Nebraska dentist as Gregory Garro Jr., DDS. The report cites a press release from acting U.S. Attorney Robert C. Stuart claiming that Dr. Garro billed Nebraska Medicaid for services he did not provide.

Dr. Garro received more than $82,000 from Nebraska Medicaid between 2013 and 2016. He is charged with 24 counts of healthcare fraud and is scheduled to appear in federal court on July 24.

In Michigan, Najah Roumayah, DDS, and David Dickey, DDS, were each charged with one count of Medicaid fraud for false claims. Drs. Roumayah and Dickey allegedly billed Medicaid for dental services that were not performed, according to the Michigan attorney general's office.

Focus on opioid-related crimes

This year's charges were also the largest action against opioid-related fraud, with the DOJ in the process of suspending or banning 295 healthcare professions for conduct related to opioid diversion and abuse. Almost one-third of the 412 defendants were charged with fraudulent prescription and distribution of opioids and other narcotics.

Among the opioid charges, one fake rehabilitation facility in Florida allegedly recruited drug addicts and then billed the federal government for more than $58 million in fraudulent services. In another case, one doctor was charged with writing 12,000 opioid prescriptions.

"This event again highlights the enormity of the fraud challenge we face," Sessions stated. "This problem is compounded by the fact that our country is in the midst of the deadliest drug crisis in our history."