$6B fraud bust includes numerous telehealth schemes

• Federal authorities charged 345 people nationwide, including more than 100 providers and four telemedicine executives, with filing more than $ 6 billion in fraudulent claims to payers. Of that amount, $ 4.5 billion went to telemedicine programs and about $ 800 million each went to drug addiction treatment and the illicit distribution of opioids.

• According to a statement issued Wednesday, more than 250 healthcare professionals have been stripped of federal healthcare billing privileges for participating in the scams.

• The US Department of Justice also said it is creating a new swift strike group to investigate fraud cases involving large providers operating in multiple jurisdictions.

Telemedicine-related fraud has increased dramatically since 2016, the HHS Inspector General said. As providers quickly switched many services to virtual procurement during the COVID-19 pandemic, fraud attempts are likely to continue.

One of the cases described Wednesday involved false claims for COVID-19 testing, while another involved a COVID-19 system used to defraud insurers worth more than $ 4 million.

The telemedicine fraud involved a marketing network that lured hundreds of thousands of people into a criminal system through phone calls, direct mail, television advertisements, and online advertisements. Telemedicine executives then paid doctors to order unnecessary medical supplies, tests, or medications, without patient interaction or with a simple phone call.

These were not given to the patients or were of no value to them. The proceeds were then laundered by shell companies and international banks.

The system appears to be a follow-up to the DOJ in April 2019 involving fraudulent telemedicine companies imposing unnecessary goods on Medicare beneficiaries in exchange for mishaps from long-standing medical device companies.

The massive bankruptcy involved the work of 175 HHS OIG agents and analysts and targeted countless fraud operations in the United States and its territories.

One of the largest scams involved 29 defendants in the Central District of Florida. A telemedicine company and health professionals working for the company paid Medicare for prescriptions for their uninsured patients.

In New Jersey, lab owners paid marketers to obtain DNA samples from places like senior health fairs. Doctors on telemedicine platforms then ordered unnecessary and medically non-reimbursable genetic testing.