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Drug Diversion Leads to Largest National Healthcare Fraud Takedown in History

The largest ever healthcare fraud enforcement action in history was announced on Thursday, June 28th, 2018 in an official press release by the Department of Justice (DOJ) and the Department of Health and Human Services (HHS).

Attorney General Jeff Sessions and the Department of Health and Human Services (HHS) Secretary Alex M. Azar III announced in a statement that the enforcement action involved 601 charged defendants involving 165 doctors, nurses, and other licensed medical professionals involving drug diversion and fraud schemes resulting in over $2 billion dollars in false billings.

The HHS also announced that from July 2017 to June 2018, it excluded 2,700 individuals in federal healthcare programs like Medicare- and Medicaid-related opioid diversion.

This crackdown on drug diversion comes as no surprise: In February and March 2018, the DEA spearheaded drug diversion investigations with help from the HHS. These led to 28 arrests, 54 enforcement actions, 150 dispensing authority revocations, and 283 administrative actions. The DEA continues to investigate individuals and companies that may be contributing to the opioid crisis, enlisting help from 41 state attorneys and the DOJ’s Opioid Fraud and Detection Unit now operating in 12 federal districts.

National Health Care Fraud and Opioid Takedown Trends

“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Gary L. Cantrell. “Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve. Though we have made significant progress in our fight against health care fraud; our efforts are not complete. We will continue to work with our partners to protect the health and safety of millions of Americans.”

Healthcare Tackles Drug Diversion

Moving forward, healthcare systems will need a strategic and proactive strategy to prevent drug diversion. Tools, technology, and a culture-first focus can help stop incidents from occurring in the first place. And when care providers address the full lifecycle of these incidents, they can continue to focus on the core of their business – building trust between patient and provider to give the best care possible.

FairWarning Patient Privacy Intelligence (PPI) helps healthcare organizations manage the full lifecycle of security incidents. Detect costly and damaging behavior like drug diversion, investigate the behavior, document the investigation, and more from one single platform that integrates with your EHRs and other mission-critical applications. For more information about how FairWarning PPI can help you prevent drug diversion in your hospital and create a culture of compliance, contact us today.