In what the U.S. Department of Justice (DOJ) calls the largest healthcare fraud crackdown in its history, more than 320 people across the country are now facing charges. The DOJ and other federal agencies are using new tools to track suspicious billing and identify fraudulent claims. If you work in healthcare, even in a non-clinical or administrative role, it’s more important than ever to understand how these investigations work and what might trigger one.
If you’re looking for a healthcare fraud lawyer, Griffin Durham Tanner & Clarkson LLC has extensive experience handling these complex cases.
DOJ files dozens of Houston-area charges
Houston has become one of the most active areas in this national crackdown. The DOJ filed 22 cases in the Houston federal court, involving dozens of healthcare providers and companies. The charges include everything from billing for unnecessary procedures to misusing COVID-19 relief funds.
Here are some of the notable allegations:
- Dr. David Jenson and Nestor Romero allegedly billed Medicare over $90 million for unnecessary “second skin” procedures. Their company received more than $45 million in reimbursements. Jenson is also accused of spending the money on personal purchases.
- Mahmood Sami Khan and Suhaib Chaudhry are charged with running a fake COVID-19 testing scheme. Prosecutors say their companies submitted over $894 million in false claims and received nearly $300 million. They allegedly laundered the money through various bank accounts.
- United Palliative & Hospice Care owners Dera Ogudo, Victoria Martinez, and Evelyn Shaw are accused of billing Medicare and Medicaid for hospice care provided to patients who were not terminally ill. The DOJ says the scheme brought in about $87 million in fraudulent payments.
- Chad Harper, a lab owner, is accused of using marketers to send business to his labs in exchange for illegal kickbacks. The labs billed Medicare approximately $115 million and were paid about $73 million.
Other cases involve accusations of billing for services never provided and providing unnecessary medical tests in exchange for payments.
Why enforcement is increasing
Several trends are driving the DOJ’s heightened focus on healthcare fraud:
- The COVID-19 pandemic created new federal programs and funding that were vulnerable to abuse.
- Advances in data analytics allow agencies to spot suspicious billing patterns more easily.
- The DOJ is working more closely with agencies like the Department of Health and Human Services and the FBI to investigate fraud.
Most of these cases involve the False Claims Act, the Anti-Kickback Statute, or money laundering charges. Some start with whistleblower reports, while others begin with a data review or billing audit.
What healthcare professionals need to know
The individuals named in these cases include physicians, pharmacists, lab owners, hospice operators, and mental health providers. In some cases, people were charged for actions they may not have known were violations. That’s part of what makes these investigations so serious.
You don’t need to be the person who submits claims or signs off on billing to be named in a government investigation. If prosecutors believe you should have known something was wrong, that alone could lead to scrutiny.
Even receiving a subpoena or target letter can be a stressful and disruptive experience. Investigations can take months or years to resolve, and they often involve detailed reviews of billing records and patient files.
Griffin Durham Tanner & Clarkson LLC has represented many clients facing this type of scrutiny. Their team includes former federal prosecutors who understand how the government builds healthcare fraud cases and how to respond effectively to them.
How to stay informed
This surge in enforcement is part of a national trend. Prosecutors are watching more closely, and agencies are investing more resources in uncovering fraud. That means anyone working in the healthcare field should be paying attention.
Now is a good time to review billing practices and employee training. If an investigator contacts your office or receives a subpoena, it’s important to understand what that means and what the next steps might look like.
Learn more about Griffin Durham Tanner & Clarkson LLC
Griffin Durham Tanner & Clarkson LLC represents clients in healthcare fraud investigations and related cases. With offices in Atlanta and Savannah, the firm works with healthcare professionals, business owners, and organizations throughout Georgia and beyond.
To learn more about how the firm handles these cases, call our Atlanta office at (404) 891-9150 or our Savannah office at (912) 867-9140, or contact us online today.
