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165 medical professionals charged in $2B DOJ, HHS healthcare fraud investigation: 5 facts

The federal government’s largest-ever investigation led by the DOJ and HHS into healthcare fraud in the U.S. stretched across 58 federal districts and included 165 medical professionals, physicians and nurses accused of allegedly profiting from false healthcare billings, according to the DOJ.

Over 600 people were charged in the investigation with committing more than $2 billion in fraud and taxpayer theft. The report details several incidences where physicians and healthcare providers allegedly committed fraud, received kickbacks or fraudulently prescribed medications.

Here are the key facts from the investigation:

1. The investigation focused on fraudulent schemes that billed Medicare, Medicaid, Tricare and private insurance companies for "medically unnecessary" services that were never completed, according to court documents.

2. According to the DOJ, 162 defendants, including 76 physicians, unlawfully distributed opioids and other prescription narcotics.

3. The report detailed how patient recruiters received kickbacks for giving beneficiary information to providers, which then submitted fraudulent bills.

4. Here is a selection of the number of individuals charged state-by-state:

● In the middle district of Florida, 21 individuals were charged with allegedly billing $21 million in fraudulent healthcare services.

● In the northern district of Illinois, 21 individuals were charged with fraudulently billing $54 million in incomplete home health and dental services.

● In the middle and eastern districts of Louisiana and the southern district of Mississippi, 42 defendants were charged with healthcare fraud, drug diversion and money laundering schemes involving more than $16 million in fraudulent healthcare billings.

● In the middle and eastern districts of Louisiana and the southern district of Mississippi, 42 defendants were charged with healthcare fraud, drug diversion and money laundering schemes involving more than $16 million in fraudulent healthcare billings.

5. In light of the investigation, the DOJ plans to hire more prosecutors and expanding data analytics resources to improve its investigatory efforts.

To view the full report, click here.

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