Operation Gold Rush – A Reminder of Just How Much Money Is Lost from Healthcare Fraud

As a simple matter of dollars and cents, it is hard to overstate just how big a problem healthcare fraud is. A good reminder of this came earlier this summer, when the Department of Justice (DOJ) announced numerous criminal indictments in “Operation Gold Rush,” targeting a multinational, multi-billion-dollar health care fraud scheme.

The Department of Justice’s “Operation Gold Rush”

What Is Operation Gold Rush?

The Russia-based leadership of this organization is alleged to have purchased numerous durable medical equipment companies in the United States and to have then submitted over $10 billion in Medicare claims using stolen identities (and personally identifying information from beneficiaries). A considerable portion of these alleged fraudulent claims involved cheap medical supplies such as urinary catheters, as small-dollar claims are less likely to attract scrutiny from either beneficiaries or the government. Thankfully, HHS OIG and CMS prevented most of these claims from being paid, though the government still estimates that the government and Medicare supplemental insurance carriers together paid out nearly a billion dollars in fraudulent claims.  

What Whistleblowers Can Do

Cases like these, involving allegations of wide-ranging, outright criminal conspiracies, are largely outside the bounds of what whistleblowers can effectively challenge through qui tam actions under the False Claims Act (FCA), which is a civil rather than criminal statute. However, the sheer scale of such schemes, along with the thought and planning required to put them into place, demonstrates how massive a problem healthcare fraud still is. In fact, one major benefit of whistleblower programs such as the FCA’s qui tam provisions is that when the government works collaboratively with private-citizen whistleblowers in pursuing civil health care fraud, it frees up federal resources to go after more egregious, outright criminal conduct.

Barrett Johnston Martin & Garrison, PLLC, stays on top of the latest developments involving healthcare fraud and False Claims Act cases to represent whistleblowers in cases all over the country. If you have information or questions regarding a potential case of health care fraud, schedule a free and confidential consultation with our firm.