DOJ, Medicare Crack Down on Over $143 Million in COVID-19 Healthcare Fraud Schemes; Is Your Healthcare Practice Staying Compliant?

The Department of Justice (DOJ) just issued a harrowing reminder to healthcare providers that have been submitting claims for Coronavirus-related testing and health services since the COVID-19 pandemic began: You’d better make sure these claims are real.

That’s because the DOJ on May 26, 2021, announced criminal charges against 14 defendants suspected of Coronavirus-related health care fraud schemes that resulted in more than $143 million in false claims. Nearly $82 million of those claims stem from testing laboratories and services in South Florida (Palm Beach and Coral Springs), while other alleged scams come from CARES Act scams in California (Los Angeles, Los Altos, Burbank), and fake testing, money laundering, and wire fraud in the New York City region (Forest Hills, Queens, Staten Island).

On top of that, more than 50 national medical providers are being investigated by the Center for Program Integrity at the Centers for Medicare & Medicaid Services (CMS) for alleged involvement in health care fraud schemes “designed to exploit the COVID-19 pandemic.”

An example, according to the DOJ:

[M]ultiple defendants offered COVID-19 tests to Medicare beneficiaries at senior living facilities, drive-through COVID-19 testing sites, and medical offices to induce the beneficiaries to provide their personal identifying information and a saliva or blood sample. The defendants are alleged to have then misused the information and samples to submit claims to Medicare for unrelated, medically unnecessary, and far more expensive laboratory tests, including cancer genetic testing, allergy testing, and respiratory pathogen panel tests.

In some cases, and as alleged, the COVID-19 test results were not provided to the beneficiaries in a timely fashion or were not reliable, risking the further spread of the disease, and the genetic, allergy, and respiratory pathogen testing was medically unnecessary, and, in many cases, the results were not provided to the patients or their actual primary care doctors.