BAD BOYS: HHS Watchdogs Have Big August, Fraudsters Be Warned

BAD BOYS: HHS Watchdogs Have Big August, Fraudsters Be Warned

Posted by Adam Kazda on 09/22/2017

BAD BOYSImproper payment noncompliance is at its highest point to date. Only fifteen agencies make up 96% of the government’s $136.7 billion in improper payments, and over 65% of those improper payments come from one agency, the Department of Health and Human Services's (HHS).

Medicaid improper payments - either due to error or fraud - totaled $36 billion in 2016, and together, Medicare’s fee-for-service and Medicare Advantage totaled close to $50 billion.

Despite these staggering numbers, fraud within HHS programs would be much worse without the ‘Bad Boy’ accountants at the HHS Office of Inspector General. Just in the month of August, 28 cases, totaling $1.5 billion, were resolved or charges brought against HHS fraud perpetrators. One case saw a doctor and owner of multiple home health companies sentenced to 10 years in prison for her role in a $60 million Medicare fraud scheme, and another case saw a registered nurse convicted in a $20 million Medicare fraud scheme.

Other August highlights include:

  • A former Social Security Judge sentenced to four years in prison for his involvement in a $550 million scheme to fraud federal disability payments.

  • Houston-area home health owner and operator was sentenced to 40 years in prison for conspiring to defraud Medicare and the State of Texas' Medicaid-funded Home and Community-Based Service and Primary Home Care Programs of more than $17 million and launder the money that he stole from Medicare and Medicaid.

  • Mylan Inc. and Mylan Specialty L.P. agreed to pay $465 million to resolve allegations that they violated the False Claims Act by knowingly misclassifying EpiPen, a branded epinephrine auto-injector drug, as a generic drug to avoid paying rebates owed to Medicaid.

  • A former medical doctor and his business partner were indicted for a $7.1 million Medicare health care fraud scheme.

  • The owner of a Houston home health agency was sentenced to 75 years in prison for her role in a $13 million Medicare fraud scheme.

  • A doctor from Texas was convicted in various health care fraud charges and was sentenced to 30 years in federal prison and ordered to pay over $268 million in restitution.

Obviously, there is work to be done in the Department of Health and Human Services when it comes to fraud and improper payments, but these stories will hopefully bring fear to HHS fraudsters and hope to taxpayers.

Check out more fraud in HHS and the stories behind the perpetrators here!


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Adam KazdaAdam Kazda
Digital Content Creator
@Adam_Kazda
Adam joined Restore Accountability in 2016 and manages the Foundation's day to day creative operations. Previously, he spent two years on Capitol Hill working for Senator Tom Coburn and Senator Jeff Flake...FULL BIO