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healthcare fraudOn September 30th, the United States Department of Justice (DOJ) announced the largest healthcare fraud takedown in the history of the department, with 345 defendants were charged with submitting $6 billion in fraudulent claims. Notably, the telehealth fraud component of the case is valued at 4.5 billion. Doctors, licensed medical professionals, and executives were involved in this nationwide scandal.

The scale of the cooperative law enforcement actions, although in the middle of a national health emergency, leave no doubt about the department’s commitment to ensuring the integrity of health care benefit programs and the safety of patients.

Acting Assistant Attorney General Brian C. Rabbitt explained, “This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country. These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain.”

Telehealth Fraud

Of the alleged cases, schemes involving telehealth and telemedicine had the largest amount of alleged fraud loss, with 86 criminal defendants in 19 judicial districts submitting $4.5 billion in allegedly fraudulent claims. According to court documents, doctors and nurse practitioners were allegedly paid by telemedicine executives to order unnecessary medical equipment as well as diagnostic testing, genetic testing, and pain medications after either no patient interaction at all or a brief phone call conversation with patients they’ve never seen or met. Pharmacies, durable medical equipment companies, and genetic testing laboratories then purchased these orders and submitted fraudulent claims to Medicare and other government insurers in exchange for illegal kickbacks and bribes.

When practiced appropriately and lawfully, telehealth can facilitate high-quality care. Unfortunately, abusers of telehealth services try to manipulate beneficiaries about their healthcare needs by misleading them, as part of their aggressive marketing techniques. These fraudulent practices result in seeking illegal reimbursement from the government for illegitimate services.

The United States Health and Human Services Deputy Inspector General Gary Cantrell explained, “Unfortunately, audacious schemes such as these are prevalent and often harmful.  Therefore, collaboration is critical in our fight against healthcare fraud.  We will continue working with our law enforcement partners to hold accountable those who steal from federal health programs and protect the millions of beneficiaries who rely on them.”

The prosecution of healthcare fraud involving telemedicine isn’t new. This recent crackdown builds on several previous efforts, including the TBHI-reported DOJ telemedicine fraud case against the  Royal Physician Network, LLC and Envision It Perfect. The alleged fraudulent activities included illegal kickbacks paid to physicians and nurse practitioners, persuading them to order durable medical equipment (DME) and billing the DME to Medicare.

Another TBHI-reported case involved the “Operation Brace Yourselves” Telemedicine and Durable Medical Equipment Takedown in April of 2019, which led to an estimated $1.2 billion loss.

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