Justice Department Announces New COVID-19 Medicare Fraud Enforcements

Posted by Nancy Clements on Jun 9, 2021 9:15:00 AM

The U.S. Department of Justice (DOJ) on May 26 announced law enforcement actions for several COVID-19-related Medicare fraud schemes totaling $143 million. The actions involved the exploitation of Centers for Medicare and Medicaid Services (CMS) policies designed to increase access to care during the COVID-19 pandemic. Fourteen defendants were charged for their actions involving the exploitation of the broadened COVID-19 emergency declaration, telehealth regulations, and rules. 

In all the DOJ has charged 14 defendants for their involvement in COVID-19-related Medicare Fraud schemes.

In response to the COVID-19 pandemic, CMS revised or amended some policies so that Medicare beneficiaries could receive a wider range of services from their doctors without having to travel to a medical facility. 

“Medical providers have been the unsung heroes for the American public throughout the pandemic,” said FBI Director Christopher Wray. “It’s disheartening that some have abused their authorities and committed COVID-19 related fraud against trusting citizens. The FBI, along with our federal law enforcement and private sector partners, are committed to continuing to combat healthcare fraud and protect the American people.”

An Arkansas testing laboratory owner who had access to Medicare beneficiary and medical provider information from prior laboratory testing orders, submitted fraudulent claims for urine drug tests and other laboratory tests, including respiratory pathogen panel and COVID-19 tests, that were not actually ordered or performed. 

Three Florida men were charged with misuse of Provider Relief Fund monies by offering kickbacks to patient brokers in exchange for referring Medicare beneficiaries to Boca Toxicology for various forms of genetic testing and other laboratory testing that they did not need.

Another lab owner in Louisiana was charged with allegedly soliciting and receiving kickbacks in exchange for referrals of urine specimens for medically unnecessary testing. He also allegedly offered to pay kickbacks for referrals of specimens for COVID-19 and respiratory pathogen testing, and thereby allegedly caused the submission of over $10 million in claims to Medicare, Medicaid, and Blue Cross Blue Shield of Louisiana for panels of expensive respiratory testing that was medically unnecessary.

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In Texas, the owner and operator of testing laboratories in Dallas and Denton, Texas, allegedly exploited temporary waivers of telehealth restrictions enacted during the pandemic by offering telehealth providers access to Medicare beneficiaries for whom they could bill consultations. In exchange, these providers agreed to refer beneficiaries to Panda’s laboratories for expensive and medically unnecessary cancer and cardiovascular genetic testing. 

A medical doctor in Queens, NY, allegedly participated in an event that advertised COVID-19 testing, authorized the COVID-19 tests, and allegedly ordered expensive and medically unnecessary cancer genetic testing for Medicare beneficiaries who attended the event. The defendant also allegedly billed Medicare for services amassed at approximately $2 million. The physician was also involved in a broader health care fraud scheme involving $17 million in claims.

“The multiple health care fraud schemes charged today describe theft from American taxpayers through the exploitation of the national emergency,” said Deputy Attorney General Lisa O. Monaco. “These medical professionals, corporate executives, and others allegedly took advantage of the COVID-19 pandemic to line their own pockets instead of providing needed health care services during this unprecedented time in our country. We are committed to protecting the American people and the critical health care benefits programs created to assist them during this national emergency, and we are determined to hold those who exploit such programs accountable to the fullest extent of the law.”

Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

For information on fraud alerts, how to report and combat COVID-19-related fraud, visit: https://www.justice.gov/coronavirus

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Topics: medical office compliance, medical fraud, Medicare fraud, medicare compliance