DOJ Announces Criminal Charges Against 138 Medical Professionals
On Sept. 17, the Department of Justice (DOJ) announced via a news release that criminal charges against 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the U.S. for their alleged participation in various healthcare fraud schemes that resulted in approximately $1.4 billion in alleged losses.
The release states that “The charges target approximately $1.1 billion in fraud committed using telemedicine (the use of telecommunications technology to provide health care services remotely), $29 million in COVID-19 health care fraud, $133 million connected to substance abuse treatment facilities, or “sober homes,” and $160 million connected to other healthcare fraud and illegal opioid distribution schemes across the country.”
According to an article from CNBC by Dan Mangan, “The telemedicine cases built on prosecutions launched in 2019 and 2020, which involved allegations of billing Medicare for fraudulent genetic cancer testing, and telemedicine executives paying doctors and others to order unnecessary durable medical equipment, diagnostic testing and medications, either without actually interacting with patients or having a brief call with ones they had never met or seen.”
Nine defendants in the cases are alleged to have engaged in various healthcare fraud schemes designed to exploit the COVID-19 pandemic, which resulted in the submission of over $29 million in false billings. In one type of scheme, defendants are alleged to have exploited policies that were put in place by the Centers for Medicare & Medicaid Services (CMS) to enable increased access to care during the COVID-19 pandemic, such as expanded telehealth regulations and rules. Defendants allegedly misused patient information to submit claims to Medicare for unrelated, medically unnecessary, and expensive laboratory tests, including cancer genetic testing.
In Mangan’s article, Assistant Attorney General Kenneth Polite Jr. of the Justice Department’s criminal division, was quoted [in a briefing to the press] saying that “We are stopping corrupt medical professionals in their tracks.”
The cases involving the illegal prescription and/or distribution of opioids involve 19 defendants and several charges against medical professionals and others who prescribed over 12 million doses of opioids and other narcotics, while submitting over $14 million in false billings.
Mangan writes that “Polite noted that opioid-related overdoses killed a ‘record number of Americans, nearly 70,000,’ last year, and that drug overdose deaths overall increased by more than 30%, with 90,000 people dead as a result in 2020.”
The release from the DOJ states that “The cases that fall into more traditional categories of healthcare fraud include charges against over 60 defendants who allegedly participated in schemes to submit more than $145 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.”
CMS Administrator Chiquita Brooks-LaSure said in a statement that “Every dollar saved is critical to the sustainability of our Medicare programs and meeting the needs of seniors and people with disabilities. CMS has taken actions against 28 providers on behalf of people with Medicare coverage and to protect the Medicare Trust Fund. Actions like this to combat fraud, waste, and abuse in our federal programs would not be possible without the successful partnership of Centers for Medicare & Medicaid Services, the Department of Justice and the U.S. Department of Health and Human Services, Office of Inspector General.”