In 2014, a 50-year-old Michigan oncologist was convicted in what many have called the worst case of medical fraud in United States history.

Dr. Farid Fata, a native of Lebanon, was falsely diagnosing and treating over 500 patients through his private clinic in the Detroit area. Through misdiagnosing patients with cancer and treating them with potent anti-cancer drugs for years, Fada pocketed nearly $35 million dollars in payments from Medicare and other insurers.The scam was uncovered when an employee noticed that patients were receiving powerful chemotherapy treatments though they were never diagnosed with any forms of cancer. After pleading guilty to 23 counts of health care fraud, conspiracy and money laundering, Fada was sentenced to 45 years in federal prison.The size of America's health care system and the complexity of health insurance makes fraud an inviting target for thieves. Because the profitability is much greater for the risk involved and the penalties are lighter, criminals have been switching from cocaine trafficking to prescription-drug fraud.The National Health Care Anti-Fraud Association estimates that health care fraud is costing the nation about $68 billion annually - about 3 percent of the nation's $2.26 trillion in health care spending - and other estimates range as high as $230 billion.The fastest-growing area of fraud involves pharmacies and prescription drugs where cases have quadrupled over the past five years.In one case a pharmacy-owner in Louisiana admitted to paying nursing-home staff to bring her unused drugs, which she repackaged and sold as new. The pharmacy then billed Medicare $2.2 million for the recycled meds between 2008 and 2013.Insurance fraud not only affects the faceless insurance providers but policyholders as well. When insurers have to pay out more in fraudulent claims, they compensate by charging customers more to balance their losses. In 2013, the FBI estimated that insurance fraud costs the average U.S. family between $400 and $700 a year in increased premiums.Last week, the Department of Health and Human Services and the Department of Justice showed they are not only operating on defense but playing some serious offense against scammers as charges were announced against 412 people in the largest combined health care fraud bust in history. The defendants, spread across 41 federal districts, include 115 doctors, nurses, and other licensed medical professionals who the DOJ alleges have extracted $1.3 billion in false billings through a variety of unconnected schemes.Over one quarter of those the defendants - including doctors - face charges for their role in prescribing and distributing opioids and other narcotics. Prescription opioids are behind the deadliest drug overdose epidemic in U.S. history. More than 52,000 Americans died of overdoses in 2015.The fraud schemes targeted by the Department of Justice were focused on Medicare, Medicaid, and TRICARE, the latter of which provides health insurance for veterans and their families. In many cases, co-conspirators were paid cash kickbacks for supplying information so that providers could bill Medicare for unprovided services.Attorney General Jeff Sessions stated that many trusted medical professionals - doctors, nurses, and pharmacists - have chosen to violate their oaths and put greed ahead of their patients."They seem oblivious to the disastrous consequences of their greed," Sessions said. "Their actions not only enrich themselves often at the expense of taxpayers but also feed addictions and cause addictions to start. The consequences are real: emergency rooms, jail cells, futures lost, and graveyards."Shapiro also announced last week that criminal charges were filed against 29 people following investigations by the Office of Attorney General's Insurance Fraud Section.In one case a western Pennsylvania man, James Nayock, was involved in a single-vehicle motorcycle accident after leaving a bar. He sustained serious injuries, including a broken leg which was treated at a hospital.Instead of accurately reporting the incident, Nayock filed a $30,000 insurance claim stating he had fallen from the bed of a stranger's pickup truck and suffered injuries. Nayock is charged with insurance fraud and theft by deception."Insurance fraud is a serious crime that impacts consumers and policyholders across our Commonwealth," Shapiro said in a news release. "We will aggressively prosecute anyone who breaks the law by providing false information to an insurance company. It's wrong, and we're taking action to stop it."While the congress has been struggling to come up with a plan to replace Obamacare, which is imploding, the justice system has been doing its part by aggressively attacking fraud within the health care and insurance systems.By JIM ZBICK |

tneditor@tnonline.com