with his last announcement this week of a criminal crackdown on 21 defendants for their alleged involvement in various healthcare fraud schemes, the DOJ underscored its commitment to aggressively prosecute individuals and companies suspected of exploiting the COVID-19 pandemic . Among those actions are a collection involving alleged billing fraud resulting from COVID testing; a group of defendants allegedly took data from patients requesting COVID tests and submitting bills to federal health programs for office visits that never happened, while another set of actions involves obtaining patient samples and then billing for more expensive lab tests. Still others involve defendants who allegedly sold fake COVID vaccination cards.
In addition to prosecuting this type of healthcare fraud, the DOJ’s most recent charges reflect an ongoing pursuit of claims against providers perceived to have abused CMS waivers of certain telehealth coverage and reimbursement requirements for enable expanded access to care during the public health emergency. According to one of the indictments, the defendant medical professional took advantage of these waivers by billing for sham telehealth encounters that did not take place and agreeing to order genetic testing and medically unnecessary EMRs in exchange of patient references. Among other things, the defendant allegedly signed orders for genetic testing and EMRs based only on brief telephone conversations with the beneficiary, if any. In exchange for these orders, the defendant received kickbacks in the form of fictitious consultation fees, beneficiary referrals, and the ability to bill Medicare for telehealth visits under the more flexible waivers of of telehealth. Another defendant is already serving time for his involvement in the same scheme.
This week’s indictment follows the DOJ’s announcement (discussed here) of one of his first civil settlements under the FCA that involved the abuse of telehealth waivers. We expect to continue to see criminal and civil lawsuits against providers who are perceived to have abused pandemic regulatory waivers, particularly in relation to the expansion of reimbursement for telehealth services.
A copy of the indictment is available here.