Multi-Billion-Dollar DOJ Medical Fraud Takedown Underscores How Elections Have Consequences

Your tax payments were wasted in the pockets of fraudsters while media and government leaders failed to track irregular spending and deserving patients fought for the program's limited dollars.

Most of us have stories of someone who desperately needs help funding medical challenges. Here's one from my circle: a working, widowed, single mother needs frequent hospitalization and probably an organ transplant. She makes just a bit too much to qualify for any kind of assistance, but not enough to make ends meet as medical bills stack up. If she could get Medicaid, it would lift a weight of worry from her many burdens. She is trying. She is sinking. There is no help for her.

We, the generous American people, expect our hard-earned money to help millions of deserving people like her. It is a betrayal to every tax-paying citizen when instead, our officials prove to be inept stewards of our money. Add another slap in America's face that, when documented fraud is handed to the propaganda press—they don't even have to dig for it— they still fail to respond with the outrage such massive fraud deserves.

Money wasted on fraud could be used to help deserving, forgotten people with sincere needs.

The Department of Justice (DOJ) recently presented its annual National Health Care Fraud Takedown. The data shows us how much the media misses, and it verifies that presidential leadership makes a major difference in how much of our money is wasted.

Trump Beats Biden at Fraud Busting 

When Republicans are in charge, more fraud money is clawed back from jumbo swindlers. In the span of two weeks, coordinated federal agencies have charged 455 defendants, including 90 doctors and other licensed medical workers for participation in health care frauds and opioid abuse schemes amounting to $6.5 billion in false medical claims, patient harm, and even death.

In the last two years, President Donald Trump and his cabinet have clawed back $21.1 billion during the National Health Care Fraud Takedown. During Joe "Auto Pen" Biden's four-year term, his team nabbed $8.5 billion. In Trump's first term, his team cleaned up $12.3 billion worth of medical fraud in the national takedown. Fraud flourished while Biden napped. This is why elections matter.

In one jaw-dropping grift, 11 defendants were charged over $2 billion in fraudulent Medicare reimbursement claims related to wound care. Sales representatives would find patients with any kind of wound, often in hospice care, and order the largest size of expensive, bioengineered skin substitutes—amniotic membrane allografts made from human placental tissue — to be placed on the wounds, even if the treatment was not needed, without working with the patient's doctor, and without proper treatment for infection.

The company bought the allografts from tissue banks, relabeled them for sale at a 2,000 percent mark-up, charging up to $1,450 per square centimeter, according to the DOJ. Of that, a 40 percent kickback was paid to marketers and medical providers who pocketed $500-600 per square centimeter.

One defendant collected bogus profits of more than $24 million, which was used to buy multi-million-dollar houses, million-dollar life insurance policies, luxury vehicles, including a $135,000 Maserati, and luxury watches.

A Texas court charged a nurse practitioner with a $906 million scheme in which she applied unnecessary allografts and billed Medicare more than $1 million per patient on average, according to the DOJ. She used your tax payments to buy high-end vehicles, real estate, and to build a $4.6 million a beach resort in the Philippines. The government seized over $30 million in bank accounts she had set up, plus, a $594,000 Ferrari 296 GTS, seven other high-end vehicles, an $865,000 custom Bulgari necklace, and $1 million worth of other luxury jewelry.

In Florida, three defendants were charged for their roles in a similar, $118 million allograft fraud scheme. Here a nurse practitioner allegedly used her take on a luxury box at an NFL stadium and over $400,000 in fine art.

In California, a hospice owner and two marketers were charged for a $27.7 million Medicare fraud scheme during which they enrolled patients who were not terminally ill. But they got worried that Medicare might use data analytics to monitor patients discharged from hospice alive, and notice their patients were not dying. So, they allegedly paid someone at a funeral home $1,000-$3,000 each time they provided a dead Medicare beneficiary's information. The fake hospice enrolled already dead people, backdated a little paperwork, and "provided care" for cash.

In Florida, 53-year-old Jason Finkelstein—the medical director of a cardiovascular testing and treatment practice—was charged in an $89 million scheme billing for unnecessary cardiovascular tests, such as EKGs and echocardiograms, conducted on student athletes on school campuses. He allegedly approved test results without reviewing them.

That may have cost a young athlete his life.

Kaiden Francis, a freshman basketball player at the University of Mobile in Alabama, suffered from an enlarged heart condition. Finkelstein allegedly spent just 11 seconds reviewing all 63 cardiovascular test images in Francis’ case before signing off on the results as "normal."

Francis died 24 days later during a practice game. Yet the company continued its bogus testing.

"His parents were told he was fine," said Dr. Mehmet Oz, Administrator for the Centers for Medicare and Medicaid Services, while holding up a photo of Francis. "And despite all these internal communications that we revealed, which acknowledged by the company that they knew these were not normal tests, and they had done something terribly wrong, they kept doing it. So that kid was hurt irreparably—passed away because nothing was done about these fraudsters—and they went right after it. Their company billed over $90 million while a child was buried by their family. No remorse whatsoever."

Unimpressed Press 

Oz spoke at a nearly hour-long DOJ-led joint press conference detailing highlights of the fraud take down.

Robert F. Kennedy, Jr., Secretary of the Department of Health and Human Services (HHS), described how the Biden Administration implemented a "pay and chase" plan where the government pays Medicare and Medicaid reimbursements quickly without verifying the service. If they find fraud later, they chase after the payment to get the money back.

"We know when billing, when invoices come into my agency, we can tell that some of them are fraudulent or probably fraudulent, and the new system said we're not going to stop those payments, we want everybody paid, and then we'll claw them back at the end. It was called pay and chase," Kennedy said. "But of course, we never claw back anything."

Career HHS employees told Kennedy the Biden Administration instructed them to focus on enrollment, not fraud.

The Biden administration also deeply cut staff on the HHS Program Integrity Office.

"When my predecessor came into office, there were 80 people in Program Integrity, which is not enough, because 50 states and five territories—and when I got in, there was only six left, so all of those people were transferred or let go, and we were literally doing no program integrity," Kennedy said. "That opened up the floodgates for all of this fraud . . . . The federal government paid claims first, and chased fraud after the money was out the door, and that approach, of course, failed taxpayers. We are ending it. HHS is replacing the old pay and chase system with a detect and preventive strategy that identifies suspicious claims before the taxpayer dollars ever leave the treasury."

He explained how HHS is using AI as part of the strategy to combat fraud.

Members of the national news media responded with a collective yawn.

Acting Attorney General Todd Blanche took questions from the media, noting they would not take off-topic questions because top agency officials had limited time and were there to answer questions about this major operation. Those officials included Oz, Kennedy, FBI Director Kash Patel; Colin McDonald, Assistant Attorney General for the DOJ National Fraud Enforcement Division; Andrew Ferguson, Chairman Federal Trade Commission; Terrance Cole, Administrator of the U.S. Drug Enforcement Administration (DEA); and Matthew Millhollin, Acting Deputy Executive Associate Director for Homeland Security Investigations (HSI).

Few reporters had questions. A total lack of curiosity. Apparently, the story isn't as sexy as the hot topic of the week—coloring the Trump administration as a failure because of algae growing in Washington's recently refurbished reflecting pool.

"Will you take one off-topic question?" one reporter asked.

"No," Blanche answered. "Any other questions?" Crickets. "Alright. Thanks everybody for coming."

A working media would have cracked some of the stories the DOJ revealed before officials tracked them down, but few investigative reporters remain at local news outlets, where local fraud is first noticed. National media is too busy spinning politics to search for bona fide wrongdoing. And they are not about to talk about damaging policies Biden's people implemented or give Trump a win for record breaking fraud busting.

We need to remember all of this the next time we are asked to vote for any candidate. Leadership, or lack of leadership, in our public agencies, in newsrooms, and in our elected officials steers our culture.

When wimps lead, they ignore things like fraud, and they throw a lot of money at problems without oversight.

Strong leaders put serious people with integrity at the table who know the difference between right and wrong. In this case it has saved billions of taxpayers' money that can be spent as tax payers intend.

Kennedy said around $100 billion in fraud a year is stolen from HHS each year.

"The $100 billion dollars that Secretary Kennedy mentioned is stolen from Medicare and Medicaid," Oz said. "If we were able to just take that out of what's being stolen from Medicare, it would double the life expectancy of the Medicare trust fund."

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