The U.S. Justice Department announced a $1.2 billion healthcare fraud crackdown Wednesday, revealing charges against 36 defendants for fraudulent billing schemes related to telemedicine and equipment.
The FBI published charges this week in 13 districts to seek convictions against clinical lab owners, marketers, medical professionals, and telemarketing executives.
Prosecutors estimate that the schemes intended to defraud Medicare of $1.2 billion, but they only ended up taking $440 million.
" The charges are against people who used Medicare funds for luxury items, medical professionals approving tests and equipment that weren't necessary, and business owners submitting false or fraudulent claims for services patients don't need," Ken Polite, the head of the DOJ's criminal division told Reuters.
The Centers for Medicare Services, affiliated with the Department of Health and Human Services, took parallel administrative action against 52 companies that were part of the same scheme.
The fraud schemes involved old and well-known practices that target the Medicare program and some new emerging practices. They engaged in a new fraudulent practice that involved preying on patients' fear of cardiovascular disease and tricking them into running unnecessary cardiovascular disease screening tests.
Billing for these cardiovascular genetic tests increased tremendously in the past year, to as much as $10,000. Some of these tests have claims that pay out $8,000.
According to an official, the total amount billed for cardiovascular testing fraud was $748 million. $223 million of this was paid, and the figures include genetic cancer screenings.
Prior to the pandemic, investigators focused on schemes involving billings of unnecessary medical equipment purchases like crutches, walkers and genetic testing screenings for risks of developing inherited cancer.
Reuters reported that the U.S. is probing more than 300 cases involving genetic test schemes where senior citizens were tricked into testing for potential cancers through cheek swabs.
In many cases, doctors without relationships with the patients ordered the tests, sent them to labs, and billed Medicare.
A lab featured in the government report was raided in an operation dubbed Operation Double Helix as part of the federal agency's crackdown on fraudulent genetic tests.
While telemedicine was used in some fraud schemes before, its use has increased since the pandemic as certain tax rules were relaxed to make telemedicine more accessible to patients.
The department has had more than 200 defendants in telemedicine schemes and claims to have had an alleged loss of more than $10 billion.
Source: https://www.reuters.com/world/us/us-announces-12-bln-healthcare-crackdown-tied-telehealth-cardiovascular-tests-2022-07-20/
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