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The federal prosecutor has charged 14 people – including a doctor and owner of laboratories, pharmacies and a home health department – with multiple Covid-related fraud programs that allegedly charged consumers and insurers with $ 143 million, the Justice Department said on Wednesday.
In addition, the Center for Program Integrity at Centers for Medicare & Medicaid Services announced that it had taken administrative action against more than 50 medical providers for their involvement in healthcare fraud programs related to Covid-19.
The DOJ’s fraud division, which heads the Medicare Fraud Strike Force, announced that it is pursuing cases in the following counties: Western District of Arkansas, Northern District of California, Middle District of Louisiana, Central District of California, Southern District of Florida, Borough of New Jersey and the eastern borough of New York.
“These health professionals, executives and others have allegedly taken advantage of the COVID-19 pandemic to fill their own pockets instead of providing the health services they need in our country at this unprecedented time,” said Assistant Attorney General Lisa Monaco. “We are determined to hold those who use such programs accountable to the fullest extent of the law.”
FBI Director Christopher Wray also said the agency is determined to tackle Covid-related fraud in the healthcare sector. “Medical providers have been the unsung heroes … It is disheartening that some have abused their agencies.”
The defendants allegedly ran various types of programs “to take advantage of the COVID-19 pandemic,” the DOJ said in a press release.
“For example, several defendants offered Medicare beneficiaries COVID-19 testing in retirement homes, COVID-19 testing sites and doctor’s offices to induce beneficiaries to provide their personal identification information and a saliva or blood sample.” Said the DOJ. “The defendants allegedly then misused the information and samples to file claims with Medicare for unrelated, medically unnecessary, and far more expensive laboratory tests, including cancer gene tests, allergy tests and respiratory tests.” The DOJ said the proceeds from the programs were allegedly laundered by Shell companies and used to purchase exotic cars and luxury homes.
In another example, a defendant allegedly used extensions to the Telemedicine Ordinance to bring fraudulent claims to Medicare over telemedicine encounters that the DOJ said never happened. Telemedicine regulations were expanded after Covid-19 was recognized as a national emergency to give Medicare beneficiaries better access to a wider range of services so they can avoid risky trips to healthcare locations.
Here are some of the cases the DOJ has announced it will be prosecuted:
In Arkansas, a man who owns two testing laboratories was charged with more than $ 88 million in healthcare fraud in connection with an alleged fraud program against the United States. The man allegedly used access to beneficiary and medical provider information from previous laboratory test assignments to file hundreds of fraudulent claims for urine, drug and other tests. Some of the incorrectly submitted applications concerned deceased beneficiaries.
A doctor in New Jersey allegedly ordered expensive and medically unnecessary cancer genetic testing for Medicare beneficiaries attending a Covid-19 testing event he attended. The man also reportedly billed Medicare for services to beneficiaries he had never performed, totaling around $ 19 million in healthcare fraud programs.
Another man in the state who was a partner in a diagnostic testing lab allegedly offered setbacks in exchange for respiratory pathogen tests that were not properly bundled with Covid tests and billed to Medicare. The man reportedly paid and received bribes totaling $ 5.4 million.
In New York, charges were brought against two people who owned several pharmacies and bogus pharmacy wholesalers for allegedly guilty of healthcare fraud, wire fraud and money laundering totaling $ 45 million. The two and their co-conspirators have reportedly acquired billing privileges for several pharmacies. They also allegedly filed fraudulent claims with Medicare by abusing the Covid-19 emergency rules to avoid otherwise imposed restrictions on refilling expensive drugs. The DOJ’s press release stated that the defendants “allegedly used a sophisticated network of international money laundering operations to hide and disguise the proceeds of the system.”