DOJ Charges 15 in $2B Healthcare Fraud Schemes, Including Medi-Cal Case
The Justice Department, through the U.S. Attorney's Office for the Central District of California, charged 15 defendants, including six medical professionals, in multiple alleged healthcare fraud schemes totaling about $2 billion in fraudulent claims. The largest scheme, described as the largest substance abuse treatment fraud case ever prosecuted by DOJ, allegedly generated $1.6 billion by recruiting vulnerable patients with high-reimbursing insurance and cycling them through unnecessary treatment. Other cases involve unnecessary vascular procedures, hospice fraud, genetic testing kickbacks, and a nearly $270 million Medi-Cal pharmacy scheme that allegedly exploited a temporary suspension of prior authorization requirements, with Medi-Cal paying out about $179 million of the allegedly fraudulent claims. Eight defendants were arrested October 22, and all defendants are presumed innocent unless proven guilty.