Telemedicine, sober homes and opioids are all at the center of the largest health care fraud and opioid takedown in the United States. As reported by the United States Department of Justice, no less than 345 people have been charged with accounts of health care fraud that total over $6 billion in losses. The historic announcement of the charges was made by a unified group of departments, including the DoJ, FBI, DEA and HHS-OIG, on September 30th.
According to the DoJ report, the 345 charged defendants were found across 51 federal districts. They include more than 100 doctors, nurses and other licensed medical professionals. As mentioned, the huge takedown involves telemedicine, sober home and opioid cases.
The Telemedicine Cases.
Sullivan notes that the most alleged fraud loss related to the schemes involves telemedicine. No less than $4.5 billion in false and fraudulent claims were allegedly submitted by more than 86 criminal defendants in 19 judicial districts. The schemes involved certain telemedicine executives allegedly paying doctors and nurse practitioners to order unnecessary durable medical equipment (DME), genetic and other diagnostic testing and pain medications.
The orders were made with either no patient interaction or minimal telephone conversations with patients. The DME companies, genetic testing laboratories and pharmacies then purchased the orders in exchange for kickbacks and bribes. They then submitted false and fraudulent claims to Medicare and other government insurers.
The Sober Home Cases.
“Sober home” is the name given to a facility that offers safe housing and supportive, structured living for individuals with drug and/or alcohol addictions. The nationwide takedown involves charges against more than a dozen physicians, owners and operators of substance abuse treatment facilities and patient recruiters. They are alleged to have submitted over $845 million worth of false and fraudulent claims.
The claims were for tests and treatments for vulnerable patients who were seeking treatment for their substance additions. The defendants are alleged to have participated in schemes involving the payment of illegal kickbacks and bribes for the referral of patients to substance abuse treatment facilities. Allegedly, the patients were then subjected to medically unnecessary drug testing and therapy sessions that were frequently not provided.
The Opioid Cases.
It’s no secret that long before the coronavirus pandemic, an opioid crisis was crippling the United States. Just like COVID-19, this crisis continues. The recent nationwide takedown also involves the illegal prescription and/or distribution of opioids. There are more than 240 defendants who allegedly participated in the schemes that resulted in over $800 million in false and fraudulent claims.
Medicare, Medicaid, TRICARE and private insurance companies were all victimized. They each received bills for treatments that were medically unnecessary and often never provided. In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to provider. This enabled the providers to submit fraudulent bills to Medicare.
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