Newly Added Regional Medicare Fraud Strike Force Targets Opioid Crisis

Isabella Masini
Associate Editor
Loyola University Chicago School of Law JD 2020

One month after the largest health care fraud enforcement action was taken, the Assistant Attorney General,  Brian A. Benczkowski, of the Justice Department’s Criminal Division, announced the addition of the Newark/Philadelphia Regional Medicare Strike Force. The newly added 11th Medicare Strike Force will largely focus on healthcare fraud that is contributing to the opioid epidemic.

How Healthcare Fraud plays a Major Role the Opioid Epidemic.

According to the Center for Disease Control and Prevention, in 2016, over 40% of all U.S. opioid overdose deaths involved a prescription opioid. These prescription opioids are produced and distributed by pharmaceutical companies and healthcare facilities. Although many opioid prescriptions are used by patients who are in need of pain relief, a significant number opioid prescriptions are fraudulently distributed or acquired. As seen in the most recent enforcement action noted above, over 120 defendants out of the 412 that were charged, specifically received charges for their roles in prescribing and distributing opioids and other dangerous narcotics. Furthermore, Assistant Attorney Benczkowski noted that much of this fraudulent action by healthcare institutions is to profit, while completely disregarding the impact on those battling with addiction to opioids.

The Potential Impact of 11th Regional Medicare Strike Force.

Medicare Fraud Strike Force involves 11 regional teams that apply data analytics as well as Federal, State, and local law enforcement resources to prevent and combat health care fraud, waste, and abuse. These teams identify and terminate health care fraud schemes around the country, arrest those that participated in the fraudulent activity, and recover taxpayer dollars. As of January 2018, the Medicare Fraud Strike Force brought 2,498 indictments and 1,938 criminal actions against health care providers and institutions and recovered over three billion dollars from health care fraud schemes.

The Newark/Philadelphia Regional Medicare Strike Force is not only unique because of its focus on targeting the illegal prescription and distribution of opioids and other dangerous narcotics, but also for its chosen location. Both New Jersey and Pennsylvania are within the leading states on opioid-related overdose death rates. Even more so, Newark, New Jersey is known to be home to a dense population of pharmaceutical companies and healthcare facilities. Due to its location, the Newark/Philadelphia Strike Force can serve the population of the region it was assigned. Both the high opioid-related overdose death rate and the dense population of healthcare industries results in an ideal location for the Newark/Philadelphia Strike Force to target its efforts in identifying and establishing the best practices to combat the fraudulent prescription and distribution of opioids. Furthermore, the Newark/Philadelphia Regional Medicare Strike Force can conduct investigations, outreach, partnerships, and education with the pharmaceutical companies and healthcare facilities to ensure that the Strike Force not only arrests those who were fraudulent, but also prevent future fraudulent acts.

Since the Newark/Philadelphia Region is new to the Medicare Strike Force, it should look at current strategies in reducing healthcare fraud in the opioid industry, such as those developed by the Healthcare Fraud Prevention Partnership (HFPP).  HFPP emphasizes the importance of assisting healthcare facilities to develop resources, policies, and practices to ensure patients are provided with care that meets their needs and reduces the risk of over prescription of opioids. If the Newark/Philadelphia Strike Force applies strategies similar to those of the HFPP, its efforts will not go to waste.

The opioid epidemic is a national problem looming over the United States. However, as more governmental actions occur though enforcement, outreach, and education against healthcare fraud within to the opioid and narcotic industry by the Newark/Philadelphia Regional Medicare Strike Force, the fraudulent distribution and over prescription of opioids will hopefully decline.