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.
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.
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.