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Largest National Health Care Fraud Take-Down in History Focuses on Medicare Part D

Largest National Health Care Fraud Take-Down in History Focuses on Medicare Part D
Tuesday, June 23, 2015

On the heels of its announcement that it is “hiring additional lawyers to look into taking more administrative actions against” physicians, the Office of Inspector General (OIG) recently filed 75 indictments and 14 complaints against various parties.  The OIG’s “national sweep” yielded prosecution of $712 million in false billings and led to charges against 46 doctors and 197 others.  Most prosecutions were for egregious violations —billing for medically unnecessary and often never provided items or services.

This operation was unique in that it focused on Medicare Part D prescription drugs.  This is no surprise since spending for Part D has more than doubled since 2006, from $51.3 billion to $121.1 billion.  See HHS OIG Data Brief, June 2015.  Part of this increase is attributed to prescription drug abuse. Accordingly, prescription drug fraud schemes were one-third of the investigations.

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