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‘Tis the Season for Healthcare Enforcement

Speaking of health care, the federal government brought the heat again this summer.

As it has for several years, it announced major, coordinated raids and arrests of healthcare providers and professionals around the country. We covered the government’s raids in 2015 and 2017, and they’re getting bigger and badder each year.

This year’s takedown set new records for the number of targets and the amount of alleged fraud. The government charged 601 people—including 165 doctors, nurses, pharmacists, and other professionals—with over $2 billion in false billings to government programs like Medicare and Medicaid as well as private insurance companies. The hotspots included Florida, California, and Texas, but the raids touched 39 states in all.

For more than 160 defendants, including 76 doctors, the charges stem from the prescribing or dispensing of opioids. Other allegations include illegal kickbacks or billing for treatments that were not provided or medically necessary. Other affected providers include dentists, home-health agencies, compound pharmacies, and suppliers of durable medical equipment. The government also excluded or moved to exclude nearly 3,000 providers from federal programs in the past year. But opioids were the priority.

By the way, to come full circle, two recent studies show that opioid prescriptions have dropped dramatically in states that legalized pot. That’s according to the Journal of the American Medical Association.

But what do they know?

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