The United States Department of Justice (DOJ) charges 345 individuals – including more than 100 doctors, nurses, and other licensed medical professionals – for submitting more than $ 6 billion in false and fraudulent claims to federal health programs and private insurers.
The lion’s share of the fraudulent claims – $ 4.5 billion from 86 suspects – were for telemedicine services. Nearly $ 900 million was for the treatment of substance use disorders in so-called austere homes.
Another $ 800 million in false claims related to illicit distribution of opioids and other forms of healthcare fraud pronunciation of the notes of the federal law enforcement agency.
“These cases hold to account the medical professionals and others who have abused health care and patient benefit programs for personal gain,” Acting Assistant Attorney General Brian C. Rabbitt said in the DOJ statement.
The DOJ also said it is establishing a National Rapid Response Strike Force in its healthcare fraud unit, which will investigate and prosecute fraud cases involving major healthcare providers operating in multiple jurisdictions. The strike force led the investigation into telemedicine fraud and was a co-leader in the down-to-earth home affairs.
Sober Home arrangements
The federal government said it charged more than a dozen individuals for seeking compensation for more than $ 845 million in allegedly false and fraudulent tests and treatment claims for patients receiving drug and / or drug treatment. alcohol addiction
Those charged include doctors, owners and operators drug abuse treatment facilities and patient recruiters in 51 jurisdictions. The recruiters reportedly received bribes for referring patients to facilities where patients often underwent medically unnecessary drug testing and charged fees for therapy sessions that were often not provided. The clinicians would also have prescribed these patients medically unnecessary controlled substances and other drugs.
Sometimes patients were discharged and admitted to other facilities or referred to other labs and clinics in exchange for more bribes, the federal government reports.
The biggest sober home case was announced in August, when Michael Ligotti, DO, was charged with a plan to defraud government and private insurers of $ 681 million for medically unnecessary urine tests, blood tests, psychiatric tests, prescription drugs, and other services. Ligotti’s lawyer has denied the charges.
The government said it had filed or received guilty requests from 240 individuals pleading guilty to cases involving illegal prescription and / or opioid distribution or more traditional health care fraud, involving $ 800 million in false claims to Medicare, Medicaid, TRICARE and private insurers were involved. In many cases, this involved bribes paid to healthcare providers.
The cases allege that health care professionals and others were involved in the distribution of more than 30 million doses of opioids and other prescription narcotics.
In AlabamaTwo defendants were charged in connection with the illegal distribution of more than 50,000 opioids.
The government charged a Colorado doctor for allegedly participating in a bribe scheme with a pharmaceutical company. The doctor is said to have been given $ 300,000 to run more than 100 “speaker programs.”
The money, known as ‘fees’, was actually a series of bribes to prescribe the company’s sublingual language fentanyl spray, the DOJ said. Medicare and the state’s Medicaid program paid more than $ 4 million for the prescriptions.
A Massachusetts psychiatrist and his wife – who operated two psychopharmacology clinics – were accused of illegally importing unapproved drugs, which they administered to dozens of patients to combat withdrawal symptoms. Many of the patients reportedly experienced adverse effects.
The U.S. Health and Human Services (HHS) Office of Inspector General, which participated in the general fraud operation, said telecare fraud has been on the rise since 2016.
“Unfortunately, bad actors try to misuse telemedicine services and use aggressive marketing techniques to mislead beneficiaries about their health care needs and charge the government for illegal services,” said Gary Cantrell, deputy inspector general of HHS. comments announcement of the charges.
The Centers for Medicare & Medicaid Services (CMS) and the HHS Inspector General worked together to monitor what appeared to be suspicious claims and act on tips from Medicare and Medicaid beneficiaries. The federal government alleges that the telemedicine companies hired international marketing networks that used phone calls, direct mail, television ads, and Internet pop-up ads to target the beneficiaries.
Confirmed Medicare or Medicaid recipients would then be turned over to a physician paid by the company to issue prescriptions for drugs, lab tests, or durable medical equipment (DME). The telemedicine company would then sell those prescriptions to pharmacies, labs, or DME companies, who would mail the prescription to the beneficiary.
This was done without any interaction with the patient or with only a short telephone conversation with patients. According to the DOJ, the DME, test results, or drugs were often not provided to beneficiaries or were worthless to patients and their current doctors. But the pharmacy, lab, or equipment supplier charged Medicare or Medicaid and gave the telemedicine company a bribe.
The DOJ alleges that the proceeds of the fraudulent plan were laundered through international shell companies and foreign banks for the benefit of telemedicine executives.
Separately, the CMS Center for Program Integrity announced that it is revoking an additional 256 Medicare billing rights for medical professionals due to their involvement in such telemedicine programs.