Federal prosecutors have unsealed dozens of cases against nearly 80 defendants across the country, including 24 medical providers, alleging they engaged in healthcare and pharmaceutical fraud that led to $2.5 billion in total losses to Medicare, Medicaid, and private insurance. Over $1 billion in fraudulent claims is believed to have been paid out. This announcement followed a weeks-long coordinated federal and state law enforcement action targeting companies, providers, and other individuals in the health care industry who allegedly worked to defraud taxpayer-funded programs and target vulnerable populations.Investigators have seized assets, including bank accounts, cars, boats, and several homes, adding up to millions of dollars in value. One example of an alleged scheme is based in New Jersey and involves suppliers buying HIV medication from patients on the street, re-labeling the bottles as legitimate, and then selling them to pharmacies for distribution. In some cases, investigators have found that the bottles contain the wrong medication, improper labels, broken pills, and pebbles.

HIV medication is a common target for fraudulent claims due to its high insurance reimbursement rate, which can reach $10,000 for a month's worth. In another case unsealed Tuesday in Florida, the leaders of a software company were accused of partaking in a large-scale scheme involving unnecessary medical equipment and prescriptions submitted for reimbursement totaling $1.9 billion in claims to Medicare and other government insurers. The CEO, vice president, and former CEO of DMERx are accused of engaging in a kickback conspiracy by connecting telemedicine companies with medical providers and suppliers, and generating fake orders for reimbursement. Justice Department officials said that while telemedicine provides an opportunity for fraudsters, tools like revoking billing privileges and data analytics from medical providers are vital deterrents. Assistant Attorney General Kenneth Polite said that today's announcement "includes some of the largest and most complex cases that the Department has prosecuted" and "demonstrates the Department's commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care." Investigators from federal agencies including the FBI and Health and Human Services Department assisted in the various probes across 16 states. While only a fraction of the total losses has been recovered, the Justice Department, FBI, and HHS are focusing on preventing fraudulent funds from being paid in the first place.