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Around the nation: DOJ cracks down on healthcare fraud, charges almost 200 people


The Department of Justice (DOJ) last month charged almost 200 people, including over 70 licensed healthcare providers, for their alleged participation in $2.75 billion of healthcare fraud, in today's bite-sized hospital and health industry news from the District of Columbia, Illinois, and Texas. 

  • District of Columbia: Last month, DOJ charged 193 people, including 76 licensed healthcare providers, for their alleged participation in healthcare fraud schemes. In 145 cases, there was a total of $2.75 billion in intended losses and $1.6 billion in actual losses. Some of the allegations highlighted by DOJ include medically unnecessary amniotic wound grafts, diverted HIV medications, and online distribution of Adderall. Through an investigation with several agencies, including the Drug Enforcement Agency and the FBI, the government was able to seize over $231 million in "cash, luxury vehicles, gold and other assets," and made convictions across 32 federal districts and 11 states. "As healthcare fraud schemes continue to evolve, so will the Justice Department's investigative and prosecutorial strategies," said U.S. Attorney General Merrick Garland. "Our messages to those seeking to exploit patients and defraud government programs is clear: You cannot hide your crimes. We will find you, and we will hold you accountable." (Muoio, Fierce Healthcare, 6/28)
  • Illinois: Walgreens last month announced that it plans to close a significant portion of its roughly 8,600 stores in the United States amid ongoing financial challenges. According to CEO Tim Wentworth, 75% of the company's U.S. stores make up 100% of its adjusted operating income. Over the next three years, the company will examine the remaining 25% of its stores for potential closures. "The current pharmacy model is not sustainable," Wentworth said. He also noted that while "[c]hanges are imminent," the specifics of the situation, including the number of closures, is still fluid. In addition, even though the company is planning several closures, it does not anticipate large-scale layoffs since most employees would be able to transfer to other Walgreens locations. "You don't need to have the number of stores we have today," Wentworth said. "Reducing capacity is not a bad thing, from a payer standpoint. We can serve payers very effectively from the footprint that remains." (Gibson, CBS News, 6/27)
  • Texas: The American Heart Association (AHA) has named Stacey Rosen its 2024–2025 volunteer president-elect. Rosen is the SVP of women's health at Northwell Health and the executive director of the Katz Institute for Women's Health. Rosen will formally step into her role as volunteer president-elect in July 2025 and support the newly announced president, as well as help direct AHA's overall initiative. "I look forward to supporting AHA President, Keith Churchwell, MD, in advancing his vision for the AHA's future," Rosen said. "Together, along with all of the AHA's amazing staff and volunteers, and my colleagues at Northwell Health, we will continue our vital work to promote heart and brain health, with a special focus on the unique challenges faced by women." (Taylor, Becker's Hospital Review, 7/2)

C-SUITE CHEAT SHEET: FRAUD AND ABUSE

Download our cheat sheet to learn about fraud and abuse regulations, how to guard against potential violations, and prepare to have conversations with health system executives about compliance programs.


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