Over a hundred charged – including at least forty healthcare professionals – as US Justice Department clamps down on fraud schemes worth over $1.4BN - AML Intelligence
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Over a hundred charged – including at least forty healthcare professionals – as US Justice Department clamps down on fraud schemes worth over $1.4BN

By Dan Byrne for AMLi

CHARGES have been brought against 138 people in the United States for their involvement in a series of healthcare fraud schemes worth over $1.4BN in dirty profits.   

At least 40 are doctors, nurses, and other healthcare professionals. All have been implicated in at least one of several schemes that the US Department of Justice has been following over the past 3 years.   

Such schemes have involved COVID relief fraud, telemedicine fraud, illegal opioid distribution, and illicit activities connected to “sober homes,” the Department said in a statement Friday.  

“Health care fraud targets the vulnerable in our communities, our health care system, and our basic expectation of competent, available care,” said Calvin Shivers, Assistant Director of the FBI’s Criminal Investigative Division.  

“Despite a continued pandemic, the FBI and our law enforcement partners remain dedicated to safeguarding American taxpayers and businesses from the steep cost of health care fraud.” 

By far, the largest portion of the $1.4BN in suspected stolen funds comes from a telemedicine fraud scheme that spanned at least 11 judicial districts.  

Here, executive providers of telemedicine (the act of delivering health care services like doctor appointments remotely) paid healthcare professionals to fraudulently order complex medical equipment and tests for patients.  

These doctors and nurses usually did not have any interaction with the patients involved, and if they did, it consisted only of a brief phone call, the DOJ suggested. 

From there, the relevant equipment and testing providers purchased the various orders in exchange for kickbacks, and then submitted over $1.1BN in claims to US government healthcare funding programmes, chiefly Medicare.  

The proceeds of this massive fraud operation often ended up financing luxury personal items like real estate and yachts, the DOJ said.  

Meanwhile, it is believed that around $133M in illicit profits have been generated by a scheme involving “sober homes” – or residences for those exiting drug rehabilitation programmes.  

It has been just a year since the US began a national effort to provide these facilities, but already they have fallen victim to fraud in the form of kickbacks and bribery.  

Sober Home patients were given drug tests that were not warranted, or signed up for therapy sessions that were never provided, and the scheme orchestrators then profited from multiple claims sent to health insurance companies, the DOJ suggested.  

Often, these drug tests were billed at thousands of dollars apiece.  

The DOJ has also flagged multiple cases of COVID-19 relief fraud – a common matter of concern since programmes began in the first half of 2020.  

These fraud schemes typically involve the submission of falsified or exaggerated information in order to extort more money from government coffers, and this time, the DOJ estimates around $29M in false billings to have been submitted.  

“We have seen all too often criminals who engage in health care fraud — stealing from taxpayers while jeopardizing the health of Medicare and Medicaid beneficiaries,” said Deputy Inspector General for Investigations Gary L. Cantrell of the US health department’s Office of Inspector General.  

“Today’s announcement should serve as another warning to individuals who may be considering engaging in such illicit activity: our agency and its law enforcement partners remain unrelenting in our commitment to rooting out fraud, holding bad actors accountable, and protecting the millions of beneficiaries who rely on federal health care programs.” 

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