A pharmaceutical company marketed four drugs to doctors. The drugs had been approved by the Food and Drug Administration (FDA) for specific medical conditions—like rheumatoid arthritis, schizophrenia, and neuropathic pain—but the company promoted the drugs for other uses as well—like post-operative pain, dementia, and migraines—and sometimes in larger doses than the FDA allowed. In some cases, the company even paid kickbacks to doctors to prescribe the drugs for these other uses.
What this company did is known as off-label marketing of prescription drugs, and it’s both illegal and potentially harmful to consumers. After an investigation involving the FBI and our federal and state partners, the company pled guilty to misbranding the drugs and agreed to pay $2.3 billion to settle criminal and civil violations…the largest U.S. health care fraud settlement ever.
Latest Schemes and Scams
As part of its health care fraud program, the Bureau is looking at various fraud schemes involving:
Home health care
Durable medical equipment
We’re also focused on other health care fraud-related crime problems impacting public safety, such as:
Off-label marketing of prescription drugs
Drug diversion (prescription drugs diverted from legitimate supply sources for illicit distribution and abuse)
At the FBI, we take our health care fraud responsibilities seriously as the primary investigative agency with jurisdiction over both federal and private insurance programs. But with total health care expenditures in the U.S. expected to reach $2.26 trillion by 2016 according to the Centers for Medicare and Medicaid Services, the opportunity for fraud will continue to grow—so will our workload. That means we have to find ways to leverage our resources.
Partnerships are key. A tried-and-true method of leveraging resources is establishing partnerships. And we’ve done just that—with federal agencies like the FDA and the Drug Enforcement Administration, various state and local agencies, and private insurance groups like the National Health Care Anti-Fraud Association.
Our most recent joint endeavor? Our participation in the Department of Justice/Health and Human Services’ (HHS) Health Care Fraud Prevention and Enforcement Action Team, or HEAT, and its Medicare Fraud Strike Forces located in several major metropolitan areas.
The HEAT initiative includes senior DOJ, FBI, and HHS officials who are focusing their efforts to reduce Medicare and Medicaid fraud through enhanced cooperation. And the strike forces, which use a data-driven approach to identify unexplainable billing patterns by health care providers and then investigate these providers for possible fraudulent activity, are a vital part of the initiative. As a result of strike force efforts, more than 300 cases have been filed and close to 600 defendants charged.
Health care fraud facts
Health care fraud schemes come in all forms—fraudulent billings, medically unnecessary services or prescriptions, kickbacks, duplicate claims, etc.
Schemes target large health care programs—both public and private—as well as health care beneficiaries. (Medicare and the Medicaid are the largest programs, so they are targeted more often.)
Schemes are committed by health care providers, owners of medical facilities and laboratories, suppliers of medical equipment, organized crime groups, corporations, and even sometimes by the beneficiaries themselves.
FBI health care fraud cases sometimes cross over into other investigative areas, like organized crime, gangs, and cyber crime, where we see criminals beginning to use the proceeds from health care fraud schemes to fund their operations.
Tips for avoiding being victimized
Protect your health insurance information card like a credit card.
Beware of free health services—are they too good to be true?
Review your medical bills, like your “explanation of benefits,” after receiving health care services and ensure the dates are services are correct.
And if you suspect health care fraud, contact your local FBI office.
- 2009 DOJ/HHS health care fraud report (PDF)
by MikeNV7 years ago
How many of you would accept a 21% cut in pay if you didn't have to? Doctors don't have to. How many. Leave your comment if you are willing to accept a 21% cut in pay.I just read this rather...
by rhamson7 years ago
The latest vote to pass health care reform in congress has failed. Do we need to drop the issue or negotiate a new one?
by Silver Rose7 years ago
I don't normally get involved in political debates, but had to wade into this one. Some foolish American magazine has made the following comment:"The controlling of medical costs in countries such as Britain...
by Judy Specht14 months ago
I have been listening to how the government has a billion dollars for getting people to sign up for the Affordable Healthcare Act. Would that money have been better spent training more doctors and building new...
by Susie Lehto4 weeks ago
Trey Gowdy posted this article link on Facebook minutes ago. It is the beginning of the end of Obamacare and a legacy.* http://thirdestatenewsgroup.com/breakin … d-to-know/The repeal legislation will go to...
by Alexander A. Villarasa3 years ago
What does one expect of a piece of legislation that was voted on, and passed both by the Senate and Congress, signed into law by Pres. Obama, and certified by the Supreme Court as being constitutional? High...
Copyright © 2017 HubPages Inc. and respective owners.
Other product and company names shown may be trademarks of their respective owners.
HubPages® is a registered Service Mark of HubPages, Inc.