DOJ charges 345 people involve in more than $6 billion healthcare fraud
America ı By Jackie Allen
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In March, Medicare chief Seema Verma announced a “historic action” to make virtual medical care or telemedicine more available through the Centers for Medicare and Medicaid Services (CMS).
She temporarily lifted a variety of federal restrictions on the use of the service to expand services beyond the limited rural areas. Verma also praised telehealth, saying it could handle routine care for an older patient with diabetes without risking a visit to a medical office during the pandemic.
A Medicare recipient with mild flu-like symptoms could receive advice from a doctor at home “instead of leaving the house and sitting in a waiting room full of other vulnerable people,” said Verna.
Mike Cohen, an operations officer with the Health and Human Services (HHS) Inspector General's Office, said in April that anti-fraud "guardrails have been removed under this epidemic. The concern is that things will never go back to what they were. There will be a lot of pressure on CMS to make at least some of these changes permanent." He added that the action resulted in an increase in telemedicine fraud.
Sober homes substance abuse treatment fraud
Defendants have been charged with more than $845 million in alleged fraud connected to substance abuse treatment facilities or sober homes. And other defendants charged with over $806 million connected to fraud and illegal opioid distribution schemes nationwide.
The sober homes cases include charges against more than 12 criminal defendants related to more than $845 million of allegedly false claims for tests and treatments for patients seeking treatment for drug and alcohol problems.
Defendants include practitioners, doctors, and operators of substance abuse treatment facilities. Patient recruiters referred to in the industry, as "body brokers" were also named as defendants
The defendants allegedly participated in various schemes that involve the payment of illegal kickbacks and bribes for the referral of hundreds of patients to substance abuse treatment facilities.
Those patients received medically unnecessary drug testing, which was sometimes billed as thousands of dollars for a single test. There were also billings for therapy sessions that were not usually provided. And the result was millions of dollars of false and fraudulent claims submitted to private insurers.
Many of these cases allegedly involve the illegal prescription and/or distribution of opioids. This healthcare fraud includes charges and guilty pleas involving more than 240 defendants. It involves more than $800 million in false and fraudulent claims. Insurance companies were allegedly paying for treatments that were unnecessary and often never provided.
Increase in fraud 2016-2020
Since 2016, HHS OIG has seen a significant increase in telemedicine fraud. There have been many alleged schemes involving marketing networks that have lured thousands of individuals into a criminal scheme through telemarketing calls, direct mail, TV ads, and internet pop-up ads.
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