Healthcare Professionals Key Targets in COVID Aid Fraud Prosecutions | Fox Rothschild LLP


The crackdown on COVID-related healthcare fraud by the US Department of Justice continues to escalate. On a single day in September 2021, the Justice Department announced criminal charges against 138 defendants in 31 federal districts across the United States, alleging about $ 1.4 billion in losses. Among those charged are 42 doctors, nurses and other licensed health professionals.

For companies that have benefited from $ 2.2 trillion in federal pandemic assistance programs, this latest coercive measure demonstrates that an audit or investigation may be inevitable. Therefore, it is essential to ensure that compliance protocols are in place to avoid criminal consequences.

The CARES law

The CARES (Coronavirus Aid, Relief, and Economic Security) law, enacted in March 2020, provided emergency financial assistance in the form of grant loans to businesses to cover the payroll and other expenses specified in the framework. the Paycheque Protection Program (PPP). It also included the Provider Relief Fund, which provided necessary medical care for Americans suffering from COVID-19.

From the outset, the government was committed to ensuring that it would take action to prevent beneficiaries from fraudulently taking advantage of the CARES Act programs.

Focus on fraud in the healthcare sector

The Justice Department has focused on COVID-19 healthcare-related fraud since the start of the pandemic. As Deputy Director Calvin Shivers of the FBI’s Criminal Investigations Division recently stated, “Healthcare fraud targets vulnerable people in our communities, our healthcare system and our basic expectation of competent care. and available. Despite an ongoing pandemic, the FBI and our law enforcement partners remain committed to protecting U.S. taxpayers and businesses from the high cost of healthcare fraud. “

A coalition of federal and state law enforcement agencies are working together to investigate and prosecute suspected fraud related to COVID-19. Agencies include the Office of the Inspector General of the Department of Health and Human Services, the FBI, the Drug Enforcement Administration, the Health Care Fraud Unit of the Criminal Division’s Fraud Section, the Health Care Fraud and Appalachian Regional Prescription Opioid Strike Force and US prosecutors. ‘Offices across the country.

Recent COVID-related criminal charges

Recent criminal charges associated with the COVID-19 pandemic include various allegations related to false billing. The defendants allegedly abused patient information to submit claims to Medicare for unrelated, medically unnecessary and expensive lab tests, including genetic cancer testing.

The individual defendants are also suspected of embezzling the Provider Relief Fund money for their own personal expenses, including gambling at a Las Vegas casino and payments to a luxury car dealership.

Other recent charges include individuals accused of telemedicine fraud. In 11 judicial districts, charges were laid against 43 defendants who allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic tests and pain relievers, i.e. without any interaction with the patient, or with only a brief telephone conversation with the patients they had never met or seen each other.

Sustainable medical equipment companies, genetic testing labs, and pharmacies then bought these orders in exchange for illegal bribes and bribes. Prosecutors allege they also submitted more than $ 1.1 billion in false and fraudulent claims to Medicare and other government insurers. The complaints included bogus telehealth consultations that did not take place. Proceeds from the program were reportedly spent on luxury items, including vehicles, yachts and real estate.

The criminal charges also included allegations that the defendants made false and fraudulent requests for testing and treatment for patients seeking treatment for drug and / or alcohol addiction as part of a National Homes Initiative program. sober. Other medical professionals have been accused of over-banning millions of doses of opioids and other prescription narcotics and of submitting bogus bills.

What to expect next

The federal government will soon make available an additional $ 25.5 billion for health care providers affected by the pandemic, including $ 8.5 billion allocated to the US bailout for providers who serve rural Medicaid, the program d health insurance for children or Medicare patients; and the provider’s $ 17 billion Relief Fund.

The federal government’s estimate of $ 1.4 billion in alleged fraud-related losses to date underscores why its law enforcement efforts are escalating rapidly. Healthcare professionals and business owners should proceed with caution when taking advantage of the latest round of aid funding.

The recent wave of accusations shows that even health care fraud unrelated to the pandemic is a top priority for federal investigators. Any healthcare business owner concerned about complying with the CARES Law or concerned about potential exposure to fraud should consult a lawyer and not wait to be contacted by law enforcement. Those who have already received a subpoena or a request from a law enforcement agency should immediately consult with a lawyer who can assess the full potential of civil and criminal exposure before responding.

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