In September 2020, the U.S. Department of Justice (“DOJ”) and the U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) announced its annual health insurance fraud cases “takedown.” The report named enforcement actions that included telehealth and telemedicine fraud, otherwise known as telefraud. The DOJ targeted alleged schemes that related to opioid distribution, substance abuse treatment facilities (“sober homes”), and telehealth providers, the latter of which served as the focus of the enforcement activity. In all, 345 defendants, across 51 judicial districts were charged with allegedly submitting more than $6 billion in false and fraudulent claims to federal health care programs and to private payers. Almost 75% of that amount involve telefraud.
DOJ Telemedicine Fraud “Takedown”
As we reported in October, in US Justice Department Reports Shakedown: Telehealth & Healthcare Fraud, the DOJ is cracking down on a number of behavioral health fraud cases. Since 2016, HHS-OIG has seen a significant increase in “telefraud”: scams that leverage aggressive marketing and so-called telehealth services. The conspirators include telemedicine company executives, medical practitioners, marketers, and business owners who scammed hundreds of thousands of unsuspecting patients in their homes.
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DOJ Opioid Takedown
As we have also previously reported, opioids have been a large focus of DOJ in the past few years in an attempt to stem the opioid epidemic through increased enforcement.
- The current takedown is a continuation of those efforts. DOJ stated that the charges involved in the opioid-related takedown involved the submission of $800 million in false and fraudulent claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were allegedly medically unnecessary and often never provided.
- DOJ also continued the trend of charging medical professionals with the illegal distribution of opioids (or operating pill mills). Providers then, need to be mindful of safe opioid prescribing guidelines, develop and implement rigorous compliance programs, and keep up to date on ever-shifting federal and state laws in this area.
DOJ Sober Home Takedown
Tied into the opioid crisis has been the rise in popularity of treatment for drug and/or alcohol addiction, as well as the necessary costs of testing and treatment of those patients. The “sober homes” cases announced by DOJ include charges against more than a dozen individuals in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments. The subjects of the charges include physicians, owners, and operators of substance abuse treatment facilities, as well as patient recruiters. Those providers in the substance abuse treatment arena should be mindful of providing appropriate utilization of therapies and tests and actively monitor their patient generation/marketing activities for fraud and abuse implications.
More information about the 2020 National Health Care Fraud Takedown can be found in this factsheet.
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