During the pandemic, fraudsters allegedly misused patient information to submit claims to Medicare for unrelated, medically unnecessary and expensive laboratory tests. (Photo: Shutterstock)
The U.S. Department of Justice continues to crack down on health care fraud schemes across the nation. Late last week, the department announced criminal charges against 138 defendants it alleges were responsible for about $1.4 billion in losses.
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"This nationwide enforcement action demonstrates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain," Assistant Attorney General Kenneth Polite Jr. said. "The charges announced today send a clear deterrent message and should leave no doubt about the department's ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a continued pandemic." Major categories of fraud include:
Telemedicine: $1.1 billion
According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment; genetic and other diagnostic testing; and pain medications, either without any patient interaction or with only a brief phone conversation with patients they had never met or seen.
Durable medical equipment companies, genetic testing laboratories and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted more than $1.1 billion in false and fraudulent claims to Medicare and other government insurers. In some instances, medical professionals billed Medicare for sham telehealth consultations that did not occur as represented. The proceeds of the scheme were spent on luxury items, including vehicles, yachts and real estate.
COVID-19: $29 million
Nine defendants are alleged to have engaged in various health care fraud schemes designed to exploit the pandemic. Defendants allegedly misused patient information to submit claims to Medicare for unrelated, medically unnecessary and expensive laboratory tests, including cancer genetic testing.
Substance abuse facilities or "sober homes": $133 million
These cases include charges against more than a dozen criminal defendants in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments for vulnerable patients seeking treatment for drug and/or alcohol addiction.
Other health care fraud and illegal opioid distribution schemes: $160 million
These cases involve 19 defendants, including several charges against medical professionals and others who prescribed more than 12 million doses of opioids and other prescription narcotics, while submitting more than $14 million in false billings.
"Health care fraud targets the vulnerable in our communities, our health care system and our basic expectation of competent, available care," said Assistant Director Calvin Shivers of the FBI's Criminal Investigative Division. "Despite a continued pandemic, the FBI and our law enforcement partners remain dedicated to safeguarding American taxpayers and businesses from the steep cost of health care fraud."
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
