Justice Department Charges Dozens for $1.2 Billion in Health Care Fraud

The Department of Justice at the moment introduced felony prices towards 36 defendants in 13 federal districts throughout the United States for greater than $1.2 billion in alleged fraudulent telemedicine, cardiovascular and most cancers genetic testing, and sturdy medical gear (DME) schemes.

The nationwide coordinated legislation enforcement motion contains felony prices towards a telemedicine firm government, homeowners and executives of scientific laboratories, sturdy medical gear corporations, advertising organizations, and medical professionals.

Additionally, the Centers for Medicare & Medicaid Services (CMS), Center for Program Integrity (CPI) introduced at the moment that it took adversarial administrative actions towards 52 suppliers concerned in comparable schemes. In reference to the enforcement motion, the division seized over $8 million in money, luxurious automobiles, and different fraud proceeds.

“The Department of Justice is committed to prosecuting people who abuse our health care system and exploit telemedicine technologies in fraud and bribery schemes,” stated Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division. “This enforcement action demonstrates that the department will do everything in its power to protect the health care systems our communities rely on from people looking to defraud them for their own personal gain.”

The coordinated federal investigations introduced at the moment primarily focused alleged schemes involving the cost of unlawful kickbacks and bribes by laboratory homeowners and operators in trade for the referral of sufferers by medical professionals working with fraudulent telemedicine and digital medical know-how corporations. Telemedicine schemes account for greater than $1 billion of the full alleged supposed losses related to at the moment’s enforcement motion. These prices embrace a number of the first prosecutions within the nation associated to fraudulent cardiovascular genetic testing, a burgeoning scheme. As alleged in court docket paperwork, medical professionals made referrals for costly and medically pointless cardiovascular and most cancers genetic exams, in addition to sturdy medical gear. For instance, cardiovascular genetic testing was not a way of diagnosing whether or not a person presently had a cardiac situation and was not authorised by Medicare to be used as a normal screening check for indicating an elevated threat of creating cardiovascular circumstances sooner or later.

“Protecting the American people is at the forefront of the FBI’s mission,” stated Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “Fraudsters and scammers take advantage of telemedicine and use it as a platform to orchestrate their criminal schemes. This collaborative law enforcement action shows our dedication to investigating and bringing to justice those who look to exploit our U.S. health care system at the expense of patients.”

“Today’s enforcement action highlights our dedication to fighting health care fraud and investigating individuals who target Medicare beneficiaries and steal from taxpayers for personal gain,” stated Inspector General Christi A. Grimm of the U.S. Department of Health and Human Services. “HHS-OIG is proud to work alongside our law enforcement partners to disrupt fraud schemes that use the guise of telehealth to expand the reach of kickback schemes designed to cheat federally funded health care programs.”

One explicit case charged concerned the operator of a number of scientific laboratories, who was charged in reference to a scheme to pay over $16 million in kickbacks to entrepreneurs who, in flip, paid kickbacks to telemedicine corporations and name facilities in trade for docs’ orders. As alleged in court docket paperwork, orders for cardiovascular and most cancers genetic testing have been utilized by the defendant and others to submit over $174 million in false and fraudulent claims to Medicare—however the outcomes of the testing weren’t utilized in therapy of sufferers. The defendant allegedly laundered the proceeds of the fraudulent scheme via a posh community of financial institution accounts and entities, together with to buy luxurious automobiles, a yacht, and actual property. The indictment seeks forfeiture of over $7 million in United States forex, three properties, the yacht, and a Tesla and different automobiles.  

Some of the defendants charged on this enforcement motion allegedly managed a telemarketing community, based mostly each domestically and abroad, that lured hundreds of aged and/or disabled sufferers right into a felony scheme. The homeowners of promoting organizations allegedly had telemarketers use misleading methods to induce Medicare beneficiaries to conform to cardiovascular genetic testing, and different genetic testing and gear.

“The Centers for Medicare & Medicaid Services continues to aggressively investigate fraud, waste and abuse and has taken action to protect patients, critical health care resources and to prevent losses to the Medicare Trust Fund,” stated CMS Administrator Chiquita Brooks-LaSure. “Work like this to combat fraud, waste, and abuse in our federal programs would not be possible without the successful partnership of CMS, the Department of Justice, and the U.S. Department of Health and Human Services Office of Inspector General.”

The prices introduced at the moment allege that the telemedicine corporations organized for medical professionals to order these costly genetic exams and sturdy medical gear no matter whether or not the sufferers wanted them, and that they have been ordered with none affected person interplay or with solely a quick telephonic dialog. Often, these check outcomes or sturdy medical gear weren’t supplied to the sufferers or have been nugatory to their major care docs. 

Today’s announcement builds on prior telemedicine enforcement actions involving over $8 billion in fraud, together with 2019’s Operation Brace Yourself, 2019’s Operation Double Helix, 2020’s Operation Rubber Stamp, and the telemedicine part of the 2021 National Health Care Fraud Enforcement Action. Specifically, the Operation Brace Yourself Telemedicine and Durable Medical Equipment Takedown alone resulted in an estimated price avoidance of greater than $1.9 billion within the quantity paid by Medicare for orthotic braces within the 20 months following that enforcement motion.

Today’s enforcement actions have been led and coordinated by Acting Principal Assistant Chief Jacob Foster, Acting Assistant Chief Rebecca Yuan and Trial Attorney Catherine Wagner of the National Rapid Response Strike Force within the Criminal Division’s Fraud Section. The Fraud Section’s National Rapid Response Strike Force and the Health Care Fraud Unit’s Strike Forces (SF) in Brooklyn, Detroit, the Gulf Coast, Houston, Miami, Newark, in addition to the U.S. Attorneys’ Offices for the District of New Jersey, Eastern District of Louisiana, Eastern District of Texas, Middle District of Florida, Middle District of Tennessee, Northern District of Georgia, Northern District of Mississippi, and Western District of North Carolina are prosecuting these circumstances.

In addition to the FBI, HHS-OIG, and CPI/CMS, VA-OIG, DCIS, IRS, MFCU, DEA, and different federal and state legislation enforcement businesses participated within the operation.

Prior to the fees introduced as a part of at the moment’s nationwide enforcement motion and since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 16 strike forces working in 27 districts, has charged greater than 5,000 defendants who collectively billed federal well being care packages and personal insurers roughly $24.7 billion.

A grievance, info or indictment is merely an allegation, and all defendants are presumed harmless till confirmed responsible past an inexpensive doubt in a court docket of legislation.

Any sufferers who consider that they’ve been contacted as a part of a fraudulent telemedicine, scientific laboratory, or DME scheme ought to name to report this conduct to HHS-OIG at 1-800-HHS-TIPS.

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