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Sessions to Unveil Health-Care Fraud Crackdown This Week, Sources Say

  • Hundreds of arrests said planned in cities across the country
  • Actions target opioid treatment fraud under Obamacare plans

Attorney General Jeff Sessions is poised to announce a major law enforcement action this week targeting health-care fraud, focusing on opioid treatment programs exploiting Obamacare insurance plans, according to two people familiar with the matter.

In what is described as a nationwide sweep with hundreds of arrests being carried out across the U.S., the Justice Department is cracking down on fraudulent claims made to some of the nation’s biggest insurers, said one of the people. People who run drug addiction treatment centers that have filed bogus claims and those who have filed reimbursement claims for drugs they then sell illegally are among those to be charged, the person said.

Arrests will be carried out in cities including Miami, Chicago, Detroit and Los Angeles, the person said. Scores of arrests are expected in southern Florida, which is home to hundreds of residential drug addiction treatment centers, said the person. Federal prosecutors, some of whom have been working on cases for a year or more, were directed to accelerate their efforts in time for this month’s operation, the person said. The Government Accountability Office did an investigation and found last year that the sign-up process for the Affordable Care Act exchanges was "vulnerable to fraud."

OIG Report

In a related action, a report on opioid use is expected to be released Thursday by the Office of Inspector General for the Department of Health and Human Services. The OIG investigates waste, fraud and abuse in government health programs, including Medicare and Medicaid.

Under the continuing crackdown on opioid abuse, Mallinckrodt Plc, a maker of pain medications, on Tuesday agreed to pay $35 million to resolve allegations that it failed to notify the Drug Enforcement Administration about suspicious orders from pharmacies and pain clinics. The company denied it had behaved improperly.

This comes as a fight brews in Congress over how much money to allot for opioid treatment and as Republicans spar over how to repeal or replace the Affordable Care Act. Some Republicans want more funding to help states combat the opioid addiction epidemic, which is estimated to have killed 60,000 Americans last year. Changes to a Senate bill expected to be released later this week may include more money in addition to other changes, but it’s unclear if it will secure the 50 votes needed to pass.

While the government has been doing health-care fraud roundups every year, past actions have focused on people who were defrauding government programs, including Medicare and Medicaid. While those types of cases are still part of the roll-up, this year the emphasis will be on fraud against private insurers by treatment programs that have taken advantage of Obamacare’s more generous coverage, the person said. Both of the people who discussed the initiative asked not to be named because they weren’t...


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