Healthcare has always been ripe for fraud, so it’s no surprise that the COVID-19 pandemic created a wellspring of opportunities for those looking to make money off a tragedy. But getting away with it likely will become a lot harder, thanks to the creation of the COVID-19 Fraud Enforcement Task Force.
Launched in May by U.S. Attorney General Merrick B. Garland, the task force held its first meeting on May 28. Led by Deputy Attorney General Lisa Monaco, the task force’s aim is to “join forces against fraud and protect the integrity of government funds.”
The Department of Justice will work in partnership with other federal government agencies to combat fraud related to a number of COVID-19 relief programs including healthcare fraud.
As we first wrote about last July, COVID-related healthcare fraud began within months of the start of the pandemic. We have seen healthcare providers and suppliers commit fraud relating to the Paycheck Protection Program (PPP).
In May 2020, a Georgia woman was arrested in connection with a scheme in which she is alleged to have sought to pay and receive illegal kickbacks in exchange for referring Medicare beneficiaries for expensive cancer screening and COVID-19 tests.
In December 2020, the Department of Justice announced that two owners of more than a dozen pharmacies in New York and Long Island were indicted for their roles in a $30 million healthcare fraud and money laundering scheme in which they exploited emergency codes and edits in the Medicare system that went into effect due to the COVID-19 pandemic in order to submit fraudulent claims for expensive cancer drugs that were never provided, ordered or authorized by medical professionals.
In announcing the task force, the DOJ also announced criminal charges against 14 defendants, including 11 newly charged defendants and three charged in superseding indictments, in seven federal districts across the United States for their alleged participation in various healthcare fraud schemes that exploited the COVID-19 pandemic and resulted in more than $143 million in false billings.
Separately, the Center for Program Integrity, Centers for Medicare & Medicaid Services (CPI/CMS) announced that it took adverse administrative actions against more than 50 medical providers for their involvement in healthcare fraud schemes relating to COVID-19 or abuse of CMS programs that were designed to encourage access to medical care during the pandemic. In one scheme, defendants obtained Medicare beneficiaries’ personal information via the provision of COVID-19 tests and then used it to submit claims to Medicare for unrelated, medically unnecessary, and far more expensive laboratory tests, including cancer genetic testing, allergy testing, and respiratory pathogen panel tests.
In another scheme, defendants are alleged to have exploited expanded telehealth regulations by submitting false and fraudulent claims to Medicare for sham telemedicine encounters that did not occur. As part of these cases, medical professionals are alleged to have offered and paid bribes in exchange for the medical professionals’ referral of medically unnecessary testing.
As we wrote about in March, telehealth fraud is an area that the Health and Human Services Office of Inspector General indicated would be a priority for its investigators.
“It’s clear fraudsters see the COVID-19 pandemic as a money-making opportunity — creating fraudulent schemes to victimize beneficiaries and steal from federal health care programs,” said Deputy Inspector General for Investigations Gary L. Cantrell of HHS-OIG. “Our agency and its law enforcement partners are aggressively and effectively investigating these egregious crimes, which is made equally clear given the results of this takedown. We will continue to support the unprecedented COVID-19 public health effort by holding accountable people who use deceptive tactics to profit from the pandemic.”
The Health Law Offices of Anthony C. Vitale can assist you should you become the target of a healthcare fraud investigation. For more information contact us at 305-358-4500 or email firstname.lastname@example.org.