Feds charge hundreds of individuals in $6 billion healthcare fraud

More than 340 individuals were charged with submitting $6 billion in fraudulent claims to federal healthcare programs and private insurers for telehealth consultations and substance abuse treatment, among other services, the Justice Department announced Wednesday, describing it as the largest healthcare fraud “takedown” in history.

About $4.5 billion of the alleged fraud involved telehealth, where telehealth executives were accused of paying doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and diagnostic tests and pain medication. The medical professionals either allegedly did not contact patients or had limited phone conversations, and DME companies, genetic testing labs and pharmacies would purchase those orders in exchange for kickbacks and bribes.

The defendants span telemedicine executives, owners of durable medical equipment companies and those connected to genetic testing laboratories and pharmacies across 51 judicial districts. CMS revoked the federal healthcare billing privileges for 256 medical professionals.

“This marks the largest amount of fraud ever charged by the Department of Justice in a single takedown operation,” Acting Assistant Attorney General Brian Rabbitt said during a news conference Wednesday.

Telehealth has expanded the reach of criminals, said Assistant Chief Jacob Foster, noting that related fraud cases have increased in recent years.

“The loss amounts are pretty staggering,” he said in a Q&A with reporters after the conference. “On balance, they are more than the garden variety healthcare fraud case.”

More than $845 million of the purported fraud involved substance abuse treatment, where physicians, patient recruiters and owners and operators of sober homes would allegedly offer bribes for referrals of patients who would receive unnecessary drug testing or therapy that wasn’t administered. Medical professionals would prescribe controlled substances and other medications to sober home residents to entice them to stay, investigators claim.

Those involved would recruit people from their hometowns and ship them off to so-called “sober homes,” often providing them with drugs that undercut their ability to recover, Rabbitt said during the news conference.

Fraud involving opioids accounted for $800 million in false claims, authorities said. Patient recruiters, beneficiaries and other stakeholders were allegedly paid for patient information that providers would use to submit fraudulent bills to federal healthcare programs and private insurers.

In one case, a Los Angeles hospice provider was accused of falsely certifying Medicare beneficiaries as terminally ill and giving them strong painkillers and unnecessary services that they would bill to Medicare. Those services would preclude the beneficiaries from other care, according to the indictment.

In connection with the nationwide investigation, the DOJ also created the National Rapid Response Strike Force as part of the criminal division’s healthcare fraud unit.

Healthcare fraud investigations have consistently netted the government more than $2 billion in settlements a year since 2010.

Prior to the charges announced Wednesday, the healthcare fraud strike froce charged more than 4,200 defendants who have collectively billed the Medicare program for approximately $19 billion since 2007.

Source: modernhealthcare.com

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