National Health Care Fraud Takedown Nets Hundreds, Billions in Alleged Schemes, Including West Virginia Settlements

The U.S. Attorney’s Office for the Northern District of West Virginia has announced civil settlements with two individuals as part of a significant national effort to combat health care fraud. This coordinated action, involving federal, state, and international law enforcement, has resulted in charges against 455 defendants across the country for their alleged involvement in schemes totaling over $6.5 billion in fraudulent claims, leading to substantial patient harm. The Northern District of West Virginia’s participation highlights a broader initiative aimed at protecting public health care programs and ensuring accountability for fraudulent practices within the medical community.

The nationwide health care fraud takedown is described as the largest “whole-of-government” effort to date, with cases spanning 56 federal districts and 45 U.S. states and territories. The operation involved unprecedented international cooperation, leading to the apprehension of defendants in various countries connected to massive fraud schemes. This year’s takedown is notable for its extensive use of data analytics to target egregious actors and its success in seizing over $182 million in assets. The comprehensive approach includes actions by the Centers for Medicare and Medicaid Services to suspend and revoke billing privileges for numerous providers, as well as significant civil monetary penalties and provider exclusions. The Drug Enforcement Administration has also been actively revoking authorities to handle controlled substances.

In the Northern District of West Virginia, two specific civil settlements were reached. Muhammad Salman, 64, of Bridgeport, West Virginia, agreed to pay 325,000 to resolve allegations of violating the False Claims Act and the Controlled Substances Act. These allegations include submitting claims to Medicare and Medicaid while traveling outside West Virginia and using pre-signed, invalid prescriptions issued outside the usual course of his professional practice. Jorge Roig, 58, of Weirton, West Virginia, will pay 165,900 to settle claims that he violated the Controlled Substances Act by using pre-signed, invalid prescriptions while away from his practice. Roig also faces allegations related to collecting controlled substances without proper authorization or record-keeping for their disposal. These settlements were facilitated through the efforts of the U.S. Attorney’s Office for the Northern District of West Virginia, with assistance from the West Virginia Attorney General’s Office Medicaid Fraud Control Unit in Salman’s case.

These settlements serve as a reminder to healthcare providers that practices such as submitting fraudulent claims or issuing invalid prescriptions, particularly while outside their professional jurisdiction, can lead to significant financial penalties and legal repercussions. For residents in West Virginia and across the nation, these enforcement actions aim to safeguard taxpayer funds allocated to Medicare and Medicaid, ensuring that these critical programs are not exploited by fraudulent actors. The emphasis on coordinated enforcement between various government agencies underscores a commitment to swift and decisive action against those who jeopardize patient safety and defraud public health care systems.

Article by Mel Anara, based upon information from the U.S. Attorney’s Office, Northern District of West Virginia.

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