Thursday, April 22, 2021

U.S DoJ recovered $2.6 billion from healthcare fraud cases in 2019


The Department of Justice recovered over $3 billion from False Claims cases in the 2019 fiscal year, with $2.6 billion coming form healthcare fraud schemes.

In a recent announcement, the Justice Department reported that the billions of dollars stemming from healthcare fraud cases involved a wide range of stakeholders, including drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians. This is also the tenth consecutive year that the department’s civil healthcare fraud settlements and judgments exceeded $2 billion.

“The significant number of settlements and judgments obtained over the past year demonstrate the high priority this administration places on deterring fraud against the government and ensuring that citizens’ tax dollars are well spent,” Assistant Attorney General Hunt stated in the announcement.  “The continued success of the department’s False Claims Act enforcement efforts are a testament to the tireless efforts of the civil servants who investigate, litigate, and try these important cases as well as to the fortitude of whistleblowers who report fraud.”

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The False Claims Act imposes liability on individuals and companies who defraud governmental programs. False claims include billing and services not provided, billing for the same service more than once, and inappropriate attainment of various goods and services.

Healthcare fraud continues to be a major issue each year, with the numbers climbing annually. Just recently, a federal jury found a Texas rheumatologist guilty for a $325 million healthcare fraud scheme.

The Department of Justice report released January 15 claimed that Jorge Zamora-Quezada, MD, falsely diagnosed patients with life-long diseases and treated them with toxic medications on the basis of his diagnosis.

According to evidence presented in the report, a majority of these patients were diagnosed with rheumatoid arthritis and treated with medications like chemotherapy drugs. He diagnosed some of the most vulnerable of our population including the young, elderly, and disabled. Many of these patients suffered physician and emotional harm as a result.

And to mislead the investigation, Zamora-Quezada allegedly falsified medical records, the Justice Department stated.

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Zamora-Quezada was convicted on the account of conspiracy to commit healthcare fraud, seven counts of healthcare fraud, and one count of conspiracy to obstruct justice.

The Jorge Zamora-Quezada case is similar to one of the largest healthcare frauds in history. Back in 2015, Farid Fata was sentenced to 45 years in prison for administering chemotherapy to 553 patients who were either perfectly health or did not warrant this type of treatment. In addition, he also submitted nearly $34 million in fraud claims to to Medicare and private insurance companies.

Fata pleaded guilty to 13 counts of healthcare fraud, one count of conspiracy to pay or receive kickbacks, and two counts of money laundering. Fata owned and operated seven cancer centers across Detroit.


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