Prosecutors, pandemic or no, crack down on billions in health care frauds

crackdownushealthscams-300x200With the Covid-19 pandemic ensuring that even more dollars are flooding into health care than ever, nefarious parties — including doctors, nurses, and other licensed professionals — have targeted ordinary Americans and the federal government in big-time scams. U.S. prosecutors have punched back with a nationwide fraud crackdown.

They announced that they have charged 345 individuals for “submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or ‘sober homes,’ and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country.”

The biggest part of the federal busts targeted bunko crimes in telemedicine, the medical care option that burgeoned in popularity as patients fearful of infection with the novel coronavirus sought distanced treatment.

Here’s how prosecutors assert 86 people across the country swindled the federal government out of $4.5 billion with what are alleged to be false and fraudulent claims:

“[C]ertain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief [phone] conversation with patients they had never met or seen.  Durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.”

Sound familiar? The feds busted up what they described as a similar, billion-dollar scam last year in which older patients, after seeing a torrent of TV ads for low-cost back, shoulder, and knee braces, called in for more information and were transferred to telemarketing boiler rooms. They then were conned out of important personal information before “consulting” briefly with medical personnel, who then “authorized” their need for unnecessary equipment that was billed to Medicare.

“Telemedicine,” Gary Cantrell, deputy inspector general for the Health and Human Services agency, said in a statement, “can foster efficient, high-quality care when practiced appropriately and lawfully. Unfortunately, bad actors attempt to abuse telemedicine services and leverage aggressive marketing techniques to mislead beneficiaries about their health care needs and bill the government for illegitimate services.  Unfortunately, audacious schemes such as these are prevalent and often harmful.”

With media reports indicating that the opioid abuse and drug overdose crisis has surged anew with a vengeance during the pandemic, prosecutors said they also had attacked crooked substance abuse treatments and illegal prescription and distribution of powerful painkillers.

The government said this about the sketchy facilities purportedly treating the addicted:

“The ‘sober homes’ cases …. include charges against more than a dozen criminal defendants in connection with more than $845 million of allegedly false and fraudulent claims for tests and treatments for vulnerable patients …. The subjects of the charges include physicians, owners, and operators of substance abuse treatment facilities, as well as patient recruiters (referred to in the industry as “body brokers”). These individuals are [accused of] payment of illegal kickbacks and bribes for the referral of scores of patients to substance abuse treatment facilities; those patients were subjected to medically unnecessary drug testing — often billing thousands of dollars for a single test — and therapy sessions that were frequently not provided, and which resulted in millions of dollars of false and fraudulent claims being submitted to private insurers.  Medical professionals also allegedly prescribed medically unnecessary controlled substances and other medications to these patients, sometimes to entice them to stay at the facility.  The patients were then often discharged and admitted to other treatment facilities, or referred to other laboratories and clinics, in exchange for more kickbacks.”

Prosecutors said their health care dragnet also resulted in “charges against medical professionals and others involved in the distribution of more than 30 million doses of opioids and other prescription narcotics.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, effective, and excellent health care. This has become an ordeal due to the skyrocketing cost, complexity, and uncertainty of therapies and prescription medications, too many of which turn out to be dangerous drugs.

The U.S. health care system — on which Americans spend $3.6 trillion annually — is, without doubt, plagued with waste, fraud, and abuse. Prosecutors deserve credit for aggressive efforts to root out crooked medical professionals and scam artists seeking to prey on patients and taxpayer dollars, too.

Separately, consumer officials have sounded the alarms and cautioned Americans to protect themselves against coronavirus frauds that have cost members of the public an estimated $145 million.

Swindlers have targeted victims with schemes involving “federal stimulus payments and other forms of financial relief, personal protective equipment, and unemployment and other government benefits,” as well as bunko health products, the New York Times reported:

“The data was compiled by the [Federal Trade Commission’s] Consumer Sentinel Network, which provides law enforcement agencies and the public with information about rampant forms of fraud. The network has tracked about 206,000 reports of fraud, identity theft, spam telephone calls and other potential scams related to the coronavirus that were submitted to the FTC from Jan. 1 through Sept. 22. According to Monica Vaca [of the FTC] … what is breathtaking about the reports is that the problems encompass so many aspects of consumers’ lives. ‘Shopping, making money, caring for our health, debt, travel, even romance — the list is extensive,’ Ms. Vaca said … The median loss was $300, according to data from the commission. The losses could be higher for older Americans, who are often the target of this kind of fraud, said Lucy Baker, a consumer defense associate at the United States Public Interest Research Group, which shared the data this week. Many of the victims were older.”

Consumers, officials say, should use caution in:

  • giving out personal information
  • too readily seeking to help charities they have not researched with rigor
  • and putting stock in health products purporting to offer benefits in preventing or treating Covid-19 — nostrums about which the FTC and the federal Food and Drug Administration both have warned.

Helpful information about coronavirus scams can be found by clicking here (AARP), here (FTC), and here (FDA).

Caveat emptor, folks, and, if in doubt, please err on the conservative side — take time to check out medical therapies with a trusted doctor, or talk to friends and family about gifts or purchases you have planned, and don’t rely on the internet or broadcasts (TV or radio) as a sole source of information. Be skeptical, use that great gift of common sense. We’ve got a lot of work to do to ensure we don’t get taken, and neither do our families, friends, colleagues, and government agencies.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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