Alleged schemes include bribes, sham telehealth, unneeded heart and cancer testing.
Medical fraud estimated at more than $1.2 billion led to criminal charges against 36 defendants across the country this week, federal investigators said.
Telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment (DME) all were part of schemes announced this week by the U.S. Department of Justice (DOJ). Meanwhile, the Centers for Medicare & Medicaid Services’ (CMS) Center for Program Integrity (CPI) announced adverse administrative actions against 52 providers involved in similar schemes, seizing $8 million in cash, luxury vehicles, and other fraud proceeds, according to DOJ.
“The Department of Justice is committed to prosecuting people who abuse our health care system and exploit telemedicine technologies in fraud and bribery schemes,” Assistant Attorney General Kenneth A. Polite Jr., of the Justice Department’s Criminal Division, said in a news release. “This enforcement action demonstrates that the department will do everything in its power to protect the health care systems our communities rely on from people looking to defraud them for their own personal gain.”
The announcement came just weeks after DOJ and the U.S. Department of Health and Human Services announced federal investigators won or negotiated more than $5 billion in health care fraud judgments and settlements – a record amount – in the year ended Sept. 30, 2021. The figure was part of the annual report of the federal Health Care Fraud and Abuse Control Program.
The newly announced, coordinated investigations primarily targeted laboratory owners and operators paying illegal kickbacks and bribes for medical professionals to refer patients through bogus telemedicine and digital medical technology companies. Telemedicine schemes accounted for more than $1 billion of the total intended losses in the latest enforcement actions, according to DOJ.
The charges include some of the nation’s first prosecutions related to fraudulent cardiovascular genetic testing, a burgeoning scheme, according to DOJ.
“As alleged in court documents, medical professionals made referrals for expensive and medically unnecessary cardiovascular and cancer genetic tests, as well as durable medical equipment,” the federal news release said. “For example, cardiovascular genetic testing was not a method of diagnosing whether an individual presently had a cardiac condition and was not approved by Medicare for use as a general screening test for indicating an increased risk of developing cardiovascular conditions in the future.”
Among the largest dollar amounts contained in the allegations, according to DOJ:
The federal investigators noted a complaint, bill of information or indictment is an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.