DOJ goes after $1.2B in health fraud, including telehealth, genetic testing

Dive Temporary:

  • The Justice Division has introduced felony costs in opposition to 36 defendants for fraudulent telemedicine, cardiovascular and most cancers genetic testing and sturdy medical gear schemes including as much as greater than $1.2 billion.
  • The enforcement motion primarily targets laboratory homeowners and operators who paid unlawful kickbacks and bribes in alternate for affected person referrals from medical doctors working with fraudulent telemedicine and digital medical expertise corporations.
  • Telemedicine schemes made up greater than $1 billion of the focused losses, regulators stated on Wednesday.

Dive Perception:

Regulators are cracking down on rising fraud within the healthcare business. Earlier this month, the federal authorities introduced it brokered greater than $5 billion in healthcare fraud judgments and settlements in 2021 — the most important quantity ever within the historical past of the HHS and Division of Justice’s fraud and abuse enforcement program.

The brand new enforcement motion targets defendants together with a telemedicine govt, medical laboratory administration, DME corporations, advertising and marketing organizations and medical doctors, regulators stated.

Prices allege that the telemedicine corporations organized for medical doctors to order costly genetic exams and DME no matter whether or not they have been wanted, usually with out affected person interplay or solely a quick phone name. In some circumstances, the take a look at outcomes or medical gear weren’t even supplied to sufferers.

A number of the defendants allegedly operated a telemarketing community that lured hundreds of aged and disabled sufferers into the scheme, deceiving them into agreeing to cardiovascular genetic testing, regulators stated.

Cardiovascular genetic testing is just not a way of diagnosing a cardiac situation, and isn’t permitted by Medicare as a screening take a look at for cardiovascular danger.

It’s a number of the first U.S. prosecutions associated to fraudulent cardiovascular genetic testing, the DOJ stated, calling it a “burgeoning scheme.”

In a single case, a medical laboratory operator allegedly paid greater than $16 million in kickbacks to entrepreneurs who then paid kickbacks to telemedicine corporations and name facilities in alternate for physician’s orders. That defendant then submitted over $174 million in false claims to Medicare, and allegedly used the proceeds to buy three actual property properties and luxurious autos together with a Tesla automobile and a yacht.

CMS’ oversight arm additionally took administrative motion in opposition to 52 suppliers concerned within the schemes.

The DOJ’s prior telemedicine enforcement actions have concerned greater than $8 billion in fraud.

Earlier than at present’s costs, the Well being Care Fraud Strike Drive, which started in South Florida in 2007 in response to rising fraud, has charged greater than 5,000 defendants who collectively billed private and non-private insurers $24.7 billion, the DOJ stated.

The HHS warned suppliers to be looking out for telehealth fraud schemes in a particular fraud alert posted to its web site Wednesday. Warning indicators embrace telemedicine corporations figuring out particular sufferers for a supplier, urging medical doctors to prescribe gadgets or providers with out ample data of a affected person, or compensating suppliers primarily based on the amount of things of providers ordered, the HHS stated.

Fraudulent suppliers might be held liable below the False Claims Act, federal anti-kickback legal guidelines and different felony statutes, the alert says.

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