In the Los Angeles-based Central District, most of the medical professionals were charged with schemes to defraud health insurance programs such as Medicare.
The U.S. Attorney's Office announced on June 28 it had filed 16 criminal cases against 33 Southern California defendants as part of a nationwide sweep to prosecute the alleged perpetrators of roughly $2 billion in health care fraud.
Ashlee McFarlane, former federal prosecutor and partner at Gerger Khalil & Hennessy, told Healthcare Dive via email that the takedown shows DOJ "is committing significant resources to criminally prosecuting anyone who prescribes drugs or distributes opioid prescriptions outside the normal course of medical practice".
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According to the U.S. Centers for Disease Control and Prevention, 42,000 people in the U.S. died from opioid overdoses in 2016. Notably, however, the DOJ emphasized what it described as a "particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics". The charges stem from a scheme in which Dr. Abrahamson submitted claims to Medicare and private insurance companies for procedures he did not perform, including skin grafts and wound 5 packing, among other false billings. These are despicable crimes. Today the Department of Justice is announcing the largest health care fraud enforcement action in American history. That's why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics. He thanked law enforcement agencies for their investigations. "By every measure we are more effective at finding and prosecuting medical fraud than ever".
In "many" cases, the DOJ said, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so the providers could submit fraudulent bills to Medicare. Several face charges of unlawfully dispensing controlled substances, including Dr. Peter Steiner, a psychiatrist who operated Kentuckiana Mental Health Associates, who is accused of prescribing unnecessary drugs.
Omar Zoobi, a pharmacist and co-owner of Metro Pharmacy and Metro Rx Pharmacy LLC, and Gregory Sikorski, a physician's assistant: are included in a 10-count indictment charging each with one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud, and one count of conspiracy to defraud the USA and pay and receive health care kickbacks.
Dr. Daniel Capen, 68, of Manhattan Beach, an orthopedic surgeon who agreed to plead guilty to conspiracy and illegal kickback charges of $142 million.