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78 charged in health care fraud worth $2.5 billion, feds say

Article

U.S. Department of Justice announces massive ‘two-week nationwide enforcement action’ around nation.

stethoscope and judgement hammer: © BillionPhotos.com - stock.adobe.com

© BillionPhotos.com - stock.adobe.com

Dozens of people allegedly are involved in an estimated $2.5 billion in health care fraud around the country, according to the U.S. Department of Justice (DOJ).

Federal investigators this week announced “a strategically coordinated, two-week nationwide enforcement action” that led to criminal charges against 78 people accused of health care fraud and opioid abuse schemes.

At least three physicians were included among defendants who allegedly defrauded Medicare and other programs for money to buy items including luxury cars, jewelry, and yachts, according to DOJ, which worked with the U.S. Department of Health and Human Services’ Office of Inspector General and numerous other agencies on the cases.

“These enforcement actions, including against one of the largest health care fraud schemes ever prosecuted by the Justice Department, represent our intensified efforts to combat fraud and prosecute the individuals who profit from it,” Attorney General Merrick B. Garland said in a statement. “The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs.”

Telehealth trickery

In one case, 11 defendants submitted more than $2 billion in bogus claims in a telemedicine schemes that DOJ said is one of the largest health care fraud cases ever prosecuted.

Executives at Florida-based software and services companies generated and sold templated doctors’ orders for orthotic braces and pain creams, receiving kickbacks and bribes. The plot “allegedly resulted in the submission of $1.9 billion” in phony claims for medically unnecessary items that were ineligible for Medicare reimbursement.

Defendants allegedly used “a massive telemarketing operation” to target the elderly and disabled, getting them to contact “offshore boiler rooms” where workers would up-sell unnecessary medical equipment and drugs.

When that business sold, “the new corporate leadership allegedly chose to continue the pre-existing fraud scheme,” the DOJ announcement said.

Phony pharmaceuticals

In other cases, 10 defendants allegedly submitted $370 million in fraudulent claims for prescription drugs. One defendants allegedly used a pharmaceutical wholesale distribution company to buy illegally diverted HIV medications, then resold the drugs as though they were legitimate, in a $150 million scheme, according to DOJ.

“Pharmacies purchased the misbranded medications, dispensed them to patients, and billed them to health care benefit programs, all while the defendants reaped substantial illegal profits,” the DOJ announcement said.

Opioid crisis

Other fraud cases involved $150 million in false billings, including illegal distribution of opioids and bogus clinical laboratory testing. The investigation involves at least 24 physicians and other licensed medical professionals “who lined their own pockets, including doctors who allegedly put their patients at risk by illegally providing them with opioids they did not need,” according to DOJ.

Physicians involved

Exact details were not available in every instance. DOJ published some court records of 25 defendants in cases in California, New Jersey, South Carolina, Louisiana, Michigan, New York, Washington, Wisconsin, Idaho, Florida, and Texas, with additional details to follow.

Physicians allegedly involved are:

  • Physician David Antonio Becerril, allegedly signed false orders for medical braces and genetic testing for Medicare beneficiaries he never met and did not treat, from February 2018 to September 2019. Becerril allegedly received more than $1.5 million from Medicare for signing more than 2,800 doctor’s orders, taking an average of less than 40 seconds to review and sign orders, “even approving orders for braces for nonexistent joints for patients whose limbs had previously been amputated,” according to court records.
  • Cardiologist Perry Frankel, described as a medical doctor of New York, was owner of Advanced Cardiovascular Diagnostics PLLC, which operated in Great Neck and Long Island, New York. From about September 2020 to March 2022, Frankel allegedly submitted $17 million in claims for evaluation and management services for COVID-19 testing that was not medically necessary, and received about $3 million.
  • Rodney Sosa, MD, of Southlake, Texas, allegedly worked as an independent contractor for purported telemedicine and marketing companies that submitted false claims totaling $1.4 million to federal health care programs from March to May 2019. Medicare paid about $574,000 on the claims for medically unnecessary genetic testing and durable medical equipment, with Sosa never establishing a physician-patient relationship, according to DOJ.
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