Source Image: Department of Health and Human Services Office of Inspector General
The Department of Justice ( DOJ ) charged 345 people across 51 federal districts in the largest healthcare fraud takedown in the agency’s history.
The DOJ said the charges were in connection with cases responsible for more than $6 billion in losses. Among those charged were more than 100 doctors, nurses and other medical professionals, according to the DOJ.
The billions in false claims were submitted to both public and private insurers, the DOJ said, with more than $4.5 billion connected to telemedicine schemes.
In addition, $845 million in fraud losses were linked to substance abuse treatment facilities known as “sober homes,” and $806 million was connected to other types of healthcare fraud and illegal opioid distribution.
The national takedowns were conducted jointly between the DOJ, theDepartment of Health and Human Services’ (HHS’) Office of Inspector General, the FBI, various U.S. attorneys’ offices and the Drug Enforcement Administration, according to the announcement.
“These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain,” said acting Assistant Attorney General Brian C. Rabbitt in a statement. “The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency.”
Across the telemedicine fraud causes, 86 defendants were charged across 19 districts, the DOJ said.
In some cases, telemedicine executives would induce physicians to prescribe medical devices, testing or prescription drugs that were not medically necessary after a brief phone call, with fraudulent claims then submitted to Medicare and other government payers, court documents say.
Alongside the fraud takedown, the Centers for Medicare & Medicaid Services (CMS) said it would revoke Medicare billing privileges from 256 medical professionals in connection with telemedicine fraud.
“Telemedicine can foster efficient, high-quality care when practiced appropriately and lawfully. Unfortunately, bad actors attempt to abuse telemedicine services and leverage aggressive marketing techniques to mislead beneficiaries about their health care needs and bill the government for illegitimate services,” said HHS Deputy Inspector General Gary Cantrell in a statement. “Unfortunately, audacious schemes such as these are prevalent and often harmful.”
Telemedicine fraud has been a key focus for enforcement agencies after the DOJ charged 24 people in connection with a $1.5 billion fraud scheme.