Source: United States Department of Justice
Thank you, Secretary Kennedy. Today’s record healthcare fraud charges and arrests makes clear that there is no case too big, no scheme too complex, and no hiding place too remote for our fraud-fighting team. In just 14 days, 455 defendants have been charged across the country for schemes involving over $6.5 billion in fraud. Under the leadership of President Trump, Vice President Vance, and Attorney General Blanche, the Department of Justice is aggressively scaling our offensive against anyone using health care as a front to steal from the American people.
But today’s cases allege more than the theft of taxpayer dollars. Many allege the theft of human dignity. Our sick, needy, and elderly — placing their faith in the gift of medicine — were neglected, ignored, and used for personal profit.
For example, one defendant is charged with conspiring to submit approximately $89 million in false and fraudulent claims for cardiovascular tests. This defendant allegedly used marketing tactics designed to prey on fears that student athletes could die from sudden cardiac arrest.
He then allegedly rubber-stamped test results as normal without reviewing them. Despite one patient’s test results showing an enlarged heart, the defendant allegedly signed off on the test results within approximately 11 seconds of accessing the 63 test result images. As a result, the student was cleared to play, and he suffered sudden cardiac arrest and died on the basketball court just weeks later.
That is why we cannot and will not tolerate fraud in health care.
How are we going about targeting fraud in health care? We are following the data. Data talks — and data doesn’t lie. It identifies where fraud is happening and unmasks the perpetrators driving it.
For example, our Data Analytics Team observed a dramatic spike in payments for allografts: from less than $1 billion in 2021 to over $14 billion just four years later. Our resulting investigations have led to criminal charges against 11 defendants across six districts for allograft fraud, including a company executive and eight medical professionals.
What happened here, to be clear, was not medicine. The defendants in these schemes purchased allografts for $30-$75 dollars, inflated the price up to nearly 50 times that cost — with the tab picked up by the taxpayers — and then secretly gave lucrative kickbacks for allografts applied. Marketers and nurses who took kickbacks targeted vulnerable hospice patients, making in many instances, over $1 million per patient.
These allograft fraud charges are the result of just one of our many data-driven initiatives. We are announcing today the first prosecution arising out of our Financial Intelligence Review Team, a cutting-edge effort to combine traditional data analytics with financial information. In less than 7 months, after identifying a suspicious behavioral health provider in Illinois, we brought charges against a defendant for a $67 million Medicaid fraud scheme. The defendant allegedly billed Medicaid for providing behavioral health services to patients who received no services and were actually even hospitalized at entirely separate health facilities at the time of the billings.
Today is just the beginning of a new era of health care fraud enforcement. The Fraud Division’s Health Care Fraud Unit, which led today’s nationwide takedown, is one of the best investments across the government, saving $106 for every $1 spent. And with the whole-of-government laser-focused on rooting out fraud, under the leadership of the White House Task Force to Eliminate Fraud, we are rapidly enhancing our fraud-fighting capabilities:
Today, we are announcing an agreement with the Centers for Medicare and Medicaid Services to obtain dedicated cloud computing space in the CMS’s cloud environment to run real time advanced analytical models to detect fraud;
We also are announcing agreements with the Federal Trade Commission and Customs and Border Protection to eliminate data silos and enrich our algorithms.
And we’re coordinating with prosecutors, agents, and analysts from across state and federal government at a scale and scope that has never before existed until today.
The era of getting rich off America’s health care system is over. If you defraud the American people and put profit over patients, we will do everything we can to put you in prison.
I’ll now turn the podium over to a critical partner in our fight against fraud – Director Kash Patel.