DoJ 138 Doctors in Health Care Fraud

On Sep. 17, DoJ charged 138 medical professionals health care fraud.

  • DoJ announced criminal charges against 138 defendants, including 42 doctors, nurses, other licensed medical professionals, in total of 31 federal districts across the US.
  • For alleged participation in health care fraud schemes, resulted in $1.4bn in losses.
  • Charges target $1.1 bn in fraud committed using telemedicine, $29mn in COVID-19 health care fraud, $133mn connected to substance abuse treatment facilities/sober homes, $160mn to other health care fraud, illegal opioid distribution schemes.
  • Telemedicine Fraud
  • Largest amount of alleged fraud loss charged related to telemedicine schemes.
  • Telemedicine execs allegedly paid doctors, nurse practitioners to order unnecessary durable medical equipment, genetic, other diagnostic testing, pain medications.
  • Without patient interaction/brief phone conversation with patients they had never met.
  • Durable medical equipment companies, genetic test laboratories, pharmacies bought orders in exchange for illegal kickbacks, bribes; $1.1 bn in false claims to Medicare.
  • Medical professionals billed Medicare for telehealth consultations that didn't occur.
  • Proceeds of scheme were spent on luxury items, including vehicles, yachts, real estate.
  • COVID-19 Fraud
  • 9 defendants are alleged to have engaged in health care fraud schemes designed to exploit COVID-19 pandemic, resulted in the submission of $29mn in false billings.
  • In one scheme, defendants exploited policies put in place by CMS to enable increased access to care during pandemic, such as expanded telehealth regulations, rules.
  • Misused patient information to submit claims to Medicare for unrelated, medically unnecessary, and expensive laboratory tests, including cancer genetic testing.
  • Action includes charges against 5 defendants who engaged in misuse of provider relief fund monies; part of coronavirus aid, relief, economic security (CARES) Act.
  • Used moneys for personal expenses, including Las Vegas casino gambling, luxury cars.
  • Sober Homes Cases
  • Sober homes cases announced on 1 yr anniversary of 1st national sober homes initiative in 2020, included charges against more than 12 criminal defendant.
  • $845mn of claims for tests, treatment for patients treating drug, alcohol addiction.
  • $133 million in false, fraudulent claims reflect continued effort to prosecute those who participated in kickback, bribery schemes referring patients to treatment facilities.
  • Patients subjected to medically unnecessary drug testing; often billed thousands of dollars for single test, therapy sessions that frequently were not provided; resulted in millions of dollars of false, fraudulent claims being submitted to private insurers.
  • Prescription, Opioid, Traditional Health Care Fraud
  • 19 defendants charged in cases involving illegal prescription/distribution of opioids.
  • Several charges against medical professionals, others who prescribed 12mn doses of opioids, other prescription narcotics, while submitting $14mn in false billings.
  • Cases in more traditional categories of health care fraud include charges against 60 defendants who allegedly participated in schemes, submitted $145mn in false, fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies
  • For treatments that were medically unnecessary and often never provided.

Regulators DoJ
Entity Types B/D; CNSM; Corp
Reference PR 21-891, 9/17/2021; COVID-19; CARES Act
Functions AML; Anti-Bribery; Compliance; Financial; Legal
Countries United States of America
Products Corporate; Equity; Insurance; Insurance-Health; Payments
Regions Am
Rule Type Enforcement
Rule Date 9/17/2021
Effective Date 9/17/2021
Rule Id 116200
Linked to N/A
Reg. Last Update 9/17/2021
Report Section AML & Enforcement

Last substantive update on 09/19/2021