2018 National Health Care Fraud & Opioid Takedown
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2018 National Health Care Fraud & Opioid Takedown


A.G. Sessions: Good morning. Thank you all for being here and thank you,
Secretary Azar for your leadership at HHS and the partnership that has been developed
that is producing tremendous savings for the United States and is holding to account those
who fraudulently abused our laws in a number of different ways. Last July, the Department of Justice and HHS
announced a record-breaking enforcement action against health care fraud. We coordinated the efforts of more than 1000
state and federal law enforcement officers to charge more than 400 defendants, including
56 doctors with more than $1.3 billion in health care fraud. Today I am announcing we are breaking records
again. The Department of Justice, in conjunction
with the Department of Health and Human Services, is announcing the largest health care fraud
takedown in American history. This year we are charging 601 defendants,
including 76 doctors, 23 pharmacists, 19 nurses, and other medical personnel with more than
$2 billion in health care fraud. Much of this fraud is related to our ongoing
opioid crisis, which is tremendously dangerous for America. It is the deadliest drug epidemic in the history
of this country. We have never seen anything like it. Some of our most trusted medical officials
— professionals look at their patients, vulnerable people suffering from addiction, and they
see dollar signs. That is a fact, it is painful but true. Some of these cases prove it without doubt. Since January 2017 we’ve charged nearly
200 doctors and another 220 medical personnel for opioid-related crimes.16 of those doctors
prescribed more than 20.3 million pills illegally, just 16 of the doctors. Even before today’s announcement in fiscal
year 2017, our organized drug and crime task forces indicted defendants and seized more
than $150 million. In this latest operation, with the help of
our partners and HHS, we have charged another 162 people, including 32 doctors, with illegal
distribution of opioids, just opioids. This is the most doctors and medical personnel,
unfortunately, and the most fraud the Department of Justice has ever taken on in any single
enforcement action. It is the most defendants we have charged
in health care fraud. It’s also the most opioid related fraud
defendants we have ever charged in a single enforcement action. These cases are important, not only for the
victims of these fraudsters but for the entire country. Many of these fraudsters have stolen tax dollars
and many have helped flood our streets with drugs. For example, one doctor allegedly defrauded
Medicare of more than $112 million by distributing 2.2 million unnecessary dosages of drugs like
oxycodone and Fentanyl. In another case, 13 defendants allegedly defrauded
taxpayers of more than $126 million, much of which was intended to pay for health care
for our troops. These are despicable crimes. We cannot tolerate them. We will not tolerate them. Indeed, working with Secretary Azar and his
fine team at HHS, our tactics at finding evidence of fraud and proving those cases is becoming
more sophisticated and far more effective. As Attorney General, I put in place tools
that are helping us find the fraudsters and gather evidence. One of these tools is the opioid fraud and
abuse detection unit, a new data analytics program that focuses specifically on opioid
related health care fraud. This data analytics team can tell us important
information like who are the outliers? Who are prescribing the most drugs? Who is dispensing the most? Whose patients are dying from overdoses? As part of this initiative, we have assigned
a dozen experienced prosecutors to focus solely on investigating these cases, and I have sent
these prosecutors around the country to the places where they are most needed. So, today is a historic day, but our work
is not finished. We are just getting started. We will continue to find, arrest, prosecute,
convict, and incarcerate fraudsters and dealers wherever they are. We will use the new tools that I mentioned
to stop criminals from exploiting vulnerable people and stop stealing hard earned tax dollars. We are sending a clear message to criminals
across the country. We will find you. We will bring you to justice. You will pay a very high price for what you
have done. I believe that is already deterring and preventing
fraud. I believe we are making progress. In two districts where we have health care
fraud strike forces, we have seen a 20% drop in Medicare parts A and B Billings. That equates to over $2 billion in savings
for the taxpayers. I want to thank Secretary Azar for his leadership
and his indispensable partnership. And I am so impressed with his leadership,
trust me. He is doing a fabulous job at this critically
important agency. So I want to thank our dedicated DEA, FBI,
IRS, criminal investigations, and HHS personnel for their valuable assistance and teamwork. I want to thank the 151 DOJ prosecutors around
the country, all of the staff and agents who did their part to make today’s announcement
possible. They made the entire Department of Justice
proud. DOJ personnel from 58 federal districts participated
in this operation. That’s the majority of our division and
the most we have ever participated in a health care fraud operation. Above all, I think we owe a major debt of
gratitude to the more than 1000 law enforcement officers–state, federal, local, and tribal–who
have been involved in these cases. I want to thank them and their families for
their families’ sacrifices for the service they have given to their country. So thank you and now I turn it over to my
friend, a high highly capable and important Secretary of HHS, Alex Azar. Sec. Azar: Good morning. It is great to be here, and thank you, General
Sessions, for hosting this really important event today. Thank you all for being here. In more than 70 offices across the nation,
the 1600 plus employees of the officer in of Inspector General from HHS work to protect
programs that benefit the health and welfare of the American people. They have been at it for four decades. Today we have the honor of marking the largest
health care fraud strikeforce takedown day in history. The men and women of HHS OIG collaborated
with federal, state, tribal, and local law enforcement partners for this incredible initiative. This is a significant accomplishment for the
American people, and every public servant involved should be immensely proud of their
work. Earlier this month, I had the honor of going
on a ride along with some of OIG law-enforcement officers, and it was invaluable to see their
work in action. Investigating and tracking serious criminals
and arresting them for their crimes. In fact, the arrest they made that day contributive
to the total of today’s takedown operation. Getting out into the field made vivid how
vulnerable our social safety net programs can be if we do not remain vigilant. There are criminals out there setting up fake
pharmacies, harvesting seniors’ Medicare information, and coming up with ever new ways every day
to steal from program beneficiaries and the taxpayer. These crimes have a significant impact on
defenseless Americans. Medicare and Medicaid are not just pots of
money where no one will miss $1 million here or $1 million there. They represent the hard work of generations
who pay into the system and often depend on it to lead healthy lives. The victims of these fraud schemes are the
American people, often senior citizens. This is important work for the taxpayer too. Every dollar we spend on OIG law-enforcement
returns four dollars back to the American people. And every dollar we recover from a lawbreaker
helps to provide health care to an American who needs it. As the Attorney General mentioned, criminals
have increasingly targeted an area where HHS and the entire Trump Administration are especially
focused: our country’s opioid crisis. They attack plans helping some of the most
vulnerable, those struggling with addiction, because they know those are the ones that
have the most good will. For example, one of the alleged criminals
charged today used his position that a recovery center to prescribe controlled substances
without a license while the center worked in tandem with other centers to bilk those
trying to work through recovery. Beyond the opioid epidemic, a number of other
cases include kickback schemes between providers to take advantage of Medicare beneficiaries. In one case, patient recruiters were allegedly
paid in exchange for the referral of fraudulent prescriptions. These kind of scams undercut the confidence
and trust of the American people in federal healthcare programs. The perpetrators really are despicable and
greedy people. Were lucky to have the commitment of those
at OIG and its dedicated partners to prevent, investigate and arrest those who commit these
crimes. I’m happy to be standing here today, standing
with my friend, the Attorney General and the committed members of the law-enforcement community,
to applaud the excellent work done by our public servants to protect our country, and
to recognize their dedication and courage in going after these fraudsters. Our law enforcement officers at HHS OIG work
every day to defend our country from criminals while showing proper judgement, thoughtful
strategy, and a dedication to the rule of law. I know President Trump is especially proud
of the work done by law-enforcement on these matters, protecting our seniors and preventing
the diversion of prescription drugs. Takedown day is a great day to highlight how
the finest in law enforcement go about their business and carry out their duties with unquestionable
professionalism and character. I want to, again, thank those who are involved
with today’s historical success. Let me now hand it over to the deputy inspector
general at HHS, Gary Cantrell. Thank you very much. Dep. Cantrell: Thank you Secretary Azar for your
support of OIG and all of our federal law enforcement partners in this effort to combat
healthcare fraud. This takedown has been a massive operation
requiring the skills and dedication of more than a thousand federal, state, and local
law-enforcement personnel, including 350 OIG special agents. Dealing with criminal elements can be dangerous
and each day these law enforcement personnel are on the frontlines of our effort to protect
HHS beneficiaries and programs. I would like to thank all of them for the
work they do. Today’s arrests focused on providers who illegally
provide and dispense opioids for personal gain and contribute to the ongoing opioid
crisis that threatens the health and well-being of Americans. In addition to these arrests, OIG has issued
opioid related exclusions to nearly 600 medical professionals and other individuals convicted
of illegal activity involving opioids. These bad actors are now barred from billing
federal health care programs, which further limits their ability to cause beneficiaries
harm. Disrupting appropriate prescribing and dispensing
of opioids remains a top priority for OIG. The key to OIG’s efforts is our use of data
analytics to detect unusual patterns that can then be followed up on with boots on the
ground investigative work. We had identified the full extent of sophisticated
schemes across the country. Understanding the breadth of this issue is
paramount to our efforts in combating the ongoing crisis. So today, we are releasing a report examining
Medicare part D spending on opioids, and providing descriptive details and statistics about prescribers
whose patients received extreme and questionable amounts of opioids. In this report, we identify 460,000 Medicare
beneficiaries who were receiving high dosages of opioids, well in excess of CDC guidelines. And from this data, we identified 300 prescribers
whose questionable opioid prescribing warrants further review and potential investigation. We are also releasing and opioid analysis
toolkit, intended to adjust the crisis in the Medicare program and beyond. This toolkit enables private and public sector
partners, including private health insurers in states to analyze their own prescription
drug claims data. We encourage our OIG partners like the state
Medicare fraud units, private sector payers and providers to customize resources provided
in the toolkit to analyze opioid use in the way that best meets their needs. We know that OIG and our partners here can’t
tackle this problem alone, so empowering those in the community with these analytical tools
will help us combat this issue. Last but certainly not least, I would like
to also thank the 30 state Medicaid fraud control unit from around the country that
participated in these operations. These units are important partners in our
mission to defend the integrity of the Medicaid program and our collaboration is crucial in
the fight against health care fraud. With this takedown, we have made significant
progress in this regard. Nonetheless, our work is not complete. OIG will continue to work with our federal
and state partners to protect the health and safety of millions of Americans. Now I would like to turn this over to FBI
Deputy Director David Bowdich. Dep. Dir. Bowdich: Good morning, everyone. I would like to thank the Attorney General
and Secretary Azar, and everyone who made this takedown possible, and in particular,
I’d like to thank our own folks for working so hard on this. We have had agents and analysts from our criminal
investigative division along with partners who work collaboratively as part of this takedown,
along with 34 of our field offices throughout this country on this takedown. Their toil and tenacity, and that of their
colleagues and partner agencies is what produced such great results that we can talk about
today. Health care fraud investigators and analysts
and prosecutors do not often get attention. They don’t because they toil through hundreds
of thousands and millions sometimes of documents, and there is a lot of data they have to go
through and it takes time. It is not sexy but it is incredibly important
work for the health of our economy and quite frankly, for each and every American that
uses our health care system. As the Attorney General and Secretary Azar
noted, health care fraud is a very serious problem. Our health care spending makes up over 1/6
of our economy in this nation. That is a lot of money, and any good criminal
investigator or analyst will tell you that if you want to find the criminals you have
got to follow the money. The people we’ve charged this week have
viewed our health care system as their own personal ATM’s. We see their hand at work each and every day,
certainly in the FBI but also in our partner agencies, in the FBI alone, we are working
collaboratively with our partners, over 21 healthcare fraud investigations as of today. These schemes harm every American who applies
— who pays for health care benefits, from the patient who does not get the care they
need to the business that pays the higher insurance cost to cover their employees, and
every taxpayer who funds our Medicare and Medicaid system. To detect and combat all these schemes the
FBI and our partners use every tool that we have. One of them is intelligence. Intelligence will help us spot emerging trends
throughout the nation, to help stop these criminals before they do further damage. Next is technology. Technology is incredibly important today to
help us collect and analyze all the huge amounts of electronic evidence, and quickly and efficiently
go through that evidence. Forensic accounting and analysis, these are
incredibly important skill sets necessary to work through these cases. Some of these cases are very complex and there
is extensive review of documents. We use major provider teams to surge resources
whenever the need is the greatest and we use, essentially, the same bread-and-butter investigative
techniques that we would use for any other case to include surveillance, in interviews
and interrogations, court-ordered wiretaps, undercover operations, and always, human source
information. Finally, without the strong partnerships that
you see up here behind me, we and anyone of us would not be successful in a takedown like
this. These partnerships are incredibly important. Our Medicare strike forces are currently in
place in 10 cities throughout the United States, and these forces take the best of our health
care resources from the variety of agencies, and make sure we are being as efficient as
we can to address the problem. We are also focused on stopping health care
frauds that are fanning the flames of opioid addiction and abuse throughout this country. Through the FBI’s prescription drug initiative,
we are targeting criminal enterprises that run prescription drug schemes and take advantage
of addiction for their own personal gains. Just in 2018, the FBI along with our partners
have arrested and charged well over 50 people for their role in opioid diversions schemes. Today we more than double that number. In particular, we are going after doctors
and medical professionals who violate their oaths and enable deadly addictions for their
own gain. Removing one criminal doctor from the opioid
distribution network can remove millions of pills from any one community. So together, we are doing a lot of work to
help curb health-care fraud. Those of us in law-enforcement, every one
of us know we cannot do it alone and we are not the only solution. We are part of the solution. We need the public’s help. We need your help. Everyone can take some easy steps to prevent
and stop health care fraud, and I’m going to name a few. First, report suspicious activity such as
people, providers offering money or free services to patients, things that sound too good to
be true, they usually are. Keep a sharp eye on the explanation of benefits
forms that your insurance company sends to the patient. For example, the patient, when reviewing their
forms, should scrutinize the date of treatment, the actual treatment which was administered,
and any follow-ups. In particular, we would ask those with elderly
parents to help them scrutinize and review their benefit statements. This is incredibly important because we know
our elderly are taken advantage of throughout this country. Third, protect your insurance cards and beneficiary
numbers as you would protect a credit card or other personal information. Fourth, if you know of anyone prescribing
or distributing opioids improperly, please report them to law-enforcement immediately
as many people’s lives depend on it. Finally, if you suspect fraud, please call
your local FBI office or the health and human service office of Inspector General. We are very ready to help. Working together, we believe we can reduce
health care fraud and keep our nation’s Health care system strong and healthy for those who
need it. I would like to turn things over to my colleague
from the DEA, assistant John Martin. Mr. Martin: Good morning. Over the past decade our nation has been increasingly
devastated by opioid misuse and abuse. It is an insidious epidemic, created in large
part by the over prescribing of potent opioids. This has resulted in a new generation of people
suffering from the disease of addiction. DEA plays a central role in addressing this
problem. We use all available means, administrative,
civil, and criminal, to ensure the agency’s 1.76 million registrants who handle prescription
drugs apply with the law, while ensuring the flow of legitimate prescription medication. In 2016, there were more than 63,600 drug-related
deaths. A 21% increase from 2015. This equates to approximately 174 deaths a
day. More than two thirds were opioid related. Many who misuse opioids are first prescribed
medications diverted from legitimate markets. Investigations which hold those responsible
for health care fraud and for the diversion of prescription drugs is a priority for DEA. DEA conducted multiple investigations that
resulted this week in more than 80 arrests and 62 indictments. Targets of these investigations included pharmacist,
pharmacies, medical practitioners, and other individuals who we believe were contributing
to the opioid crisis. While only a small percentage of our registrants
exploit the system for their own gain, this effort sends a clear message to those of abusing
the health care system. To give you a sense of the magnitude of this
week’s Operation I want to highlight the great work the women and men of the DEA did this
week. Following a nine-month investigation in Nashville,
DEA obtained indictments for five individuals who were part of an oxycodone prescription
drug trafficking ring that fraudulently obtained 4800 oxycodone pills for distribution throughout
Middle Tennessee. In Baton Rouge, the DEA took down a violent
drug trafficking organization running a pill press operation. This organization was churning out 40,000
counterfeit oxycodone pills per week. I want to be clear and reiterate that the
vast majority of health care professionals strive to provide the highest standard of
care for their patients. DEA has no interest in regulating the practice
of medicine, nor does it want to interfere with the private and personal relationship
between doctor and patient. At the same time, we will continue to do our
part to regulate drug distribution networks to ensure product availability for the treatments
that preserve and enhance quality of life, while working with our partners to prevent
abuse. DEA is committed to ending the opioid crisis
occurring in our communities, which unfortunately has been fueled by prescription drug misuse. DEA will continue to work with federal, state,
local, and tribal partners every day to protect our citizens while ensuring that patients
have adequate access to these critical medications. I want to thank everyone on this stage for
allowing DEA to participate in this important work. Thank you.>>This is for deputy director Bowdich, obviously
this is all very interesting and important, but I want to ask an off-topic question. I just was wondering, the directors on the
Hill talking about the IG report, I am wondering given that you have worked so closely with
Director Comey and deputy director McCabe, what you make sense of the IG report and if
you could give us a sense of what morale is like in the FBI. Dep. Dir. Bowdich: What I make of the IG report, I read
it carefully. I give the IG and his people a lot of credit. I think they did a good job. We don’t always agree with everything, but
we adopted — not adopted, but we accepted the vast majority of it. I think we have begun already to make the
changes that we said we would make in our response to that report, and that will continue
for this organization. If it makes us better, which I believe it
will and it was a productive endeavor. To turn towards the morale question, it has
been a difficult year and a half for us, as you well know. That is no secret. I will tell you our folks in this organization,
I think the problem is we have been talking about two cases that are part of the FBI. In the meantime, we have tens of thousands
of investigations going on. I talked a little bit about health care, to
tie that back into this. The prosecutors and investigators get very
little attention, very little fanfare because it is not a terrorist disruption, it’s not
a gang takedown. They are just churning through documents and
investigations day after day after day. We are not talking about it because it is
not high-profile, but the fact is it is incredibly important. You heard the statistics provided by the DEA
assistant administrator about deaths. We believe a takedown like this can help — for
initiatives like this can help with that problem. The morale has been bruised, no doubt, but
I believe in our folks 110%. They are resilient and we will continue to
try to make ourselves better based on the results of the Inspector General’s Report. And let me be clear I am not shirking away
from that report. It made some very good points. I do think it is important to note there was
not bias found in that report.>>A quick follow up on that. Peter strop was questioned by Congress behind
closed doors. The FBI lawyer told him not to answer a number
of questions which frustrated a number of members on Capitol Hill. What was the point of him going behind closed
doors if he was told not to answer a number of questions that a number of members said
were unbelievable? Dep. Dir. Bowdich: I will not address that. That is between his lawyer and him, and certainly
between us and Congress. We will address this to the best of our ability. As you know, when anyone goes up in front
of Congress, representation would be sought by the vast majority of individuals for assistance. He had an attorney with him. I don’t know what was said. I was not in the hearing and have not gotten
a readout of that hearing so I think it’s just best I leave that one alone.>>So for Mr. Martin, or anyone, is there
any indication that the actions you have taken over the past year have reduced the number
of Americans addicted to opioids or made a dent in the epidemic itself? How many people within law enforcement are
dedicated or on a percentage basis, how many people are dedicated to fighting this problem? Mr. Martin: That is a great question. I cannot get you exact numbers but maybe we
can work off-line with you afterward. For DEA, it is our top priority, bar none. We have just under about 4000 agents, we have
many diversion investigators, over 650. All of those folks and the support people
within DEA are working towards trying to reduce this epidemic. It is our number one priority. This task force right up here, and the takedown
we just did, is very important. These partnerships are what will help us on
the enforcement side and to send a message to all those health care providers– and I
am not talking a lot, but just a few health care providers that are diverting opioids
or frauding the government with Medicare or Medicaid fraud, can have a huge impact on
communities in this opioid epidemic. Takedowns like this are extremely important
for reducing.>>Have you seen the link between the number
of Americans addicted to opioids move based upon some of these enforcement actions? Mr. Martin: What I can tell you, many Americans
are still addicted to opioids. Since 2015, the number of prescription opioids
have been going down, steadily. Unfortunately, the rise of Fentanyl and synthetic
substances used to be mixed in or to be made with counterfeit pills, that has gone up in
recent years. We are focusing not only on the prescription
opioids but on synthetic opioids like Fentanyl.>>I have an opiate question for Mr. Martin. There has been some criticism in regards to
whether or not this issue, or, rather, opioids have been overregulated, sort of pushing people
to mark illegal drugs over on the street level. What are your thoughts on that, and is there
a concern that your unit or task forces will be dealing with that more often now? Mr. Martin: I don’t think they are overregulated. What I think there has been an education out
there with doctors. We know more about prescription opioids and
how addictive they can be. Like I said in my prepared remarks, this crisis
has been fueled in large part to the overprescribing of potent opioids. We at DEA and our partner agencies have tried
to get out the education message to not only the public, but the health care providers. I do see — it is not that we are over regulating,
but doctors and medical practitioners are more aware. There are a lot of people addicted to opioids
and sometimes it is easier to get street drugs.>>Thank you very much, everyone.

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