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The federal prosecutor has indicted 14 people in multiple fraud programs that allegedly charged consumers and insurers with $ 143 million, the Justice Department said on Wednesday.
In addition to those charged by the DOJ, more than 50 medical providers are facing administrative actions by the Center for Program Integrity and Centers for Medicare & Medicaid Services for participating in healthcare fraud programs related to Covid-19.
The DOJ’s Fraud Department, 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, District 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 fight healthcare fraud related to Covid-19.
The DOJ’s announcement also found that the profits from the fraudulent operations were allegedly laundered by Shell companies and used to purchase exotic cars and luxury homes.
After Covid-19 was recognized as a national emergency, telehealth regulations were expanded to allow Medicare beneficiaries better access to a wider range of services to avoid risky travel to health locations. The defendant allegedly used these amendments to bring fraudulent claims to Medicare over telemedicine encounters that the DOJ said never took place.
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 promotional event he attended. The man also reportedly billed Medicare for services to beneficiaries he had never performed, totaling around $ 19 million in healthcare fraud systems.
Another man in the state who was a partner in a diagnostic testing lab allegedly offered setbacks in exchange for breath 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, two people who owned multiple pharmacies and bogus pharmacy wholesalers were charged with allegedly guilty of healthcare fraud, cable 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 Covid-19 emergency rules to avoid otherwise imposed restrictions on refilling expensive drugs.
The report alleges that the defendants “allegedly used an ingenious network of international money laundering activities to hide and disguise the proceeds of the system.”
“Medical providers have been the unsung heroes … It’s disheartening that some have abused their agencies,” Wray said.