On September 30, 2020, the U.S. Department of Justice (“DOJ”) issued a press release regarding a nationwide enforcement action involving 345 defendants allegedly responsible for submitting more than $6 billion in fraudulent healthcare claims. According to the DOJ, the enforcement action is the largest healthcare fraud and opioid enforcement action or “takedown” in the department’s history. CG attorneys have written about the increasing trend of large scale takedowns by the DOJ. For example, in 2019, the DOJ announced “Operation Brace Yourself,” which included charges against 24 criminal defendants related to dispensing orthotic braces using telemedicine that resulted in an estimated $1.5 billion in cost avoidance, according to the DOJ.
The DOJ’s latest takedown involves alleged fraudulent actions related to telemedicine, sober homes, and other opioid and traditional healthcare fraud schemes.
In its latest takedown, the DOJ charged 86 defendants who were allegedly responsible for over $4.5 billion in fraudulent claims involving telemedicine. The fraud was operated across 19 judicial districts and included alleged kickbacks, medically unnecessary testing and orders, and the submission of fraudulent claims. The government’s focus on telemedicine is not new. In July 2020, CG attorneys wrote about the DOJ’s continued scrutiny of and enforcement efforts related to telemedicine, even during a national pandemic. The increased scrutiny of telemedicine is not limited to the DOJ and includes efforts by multiple agencies, such as the Centers for Medicare & Medicaid Services (“CMS”). For example, the DOJ’s press release also noted that CMS revoked the Medicare billing privileges of 256 additional medical professionals involved in telemedicine schemes.
The DOJ’s takedown included charges against more than a dozen defendants for fraudulent claims associated with tests and services for patients seeking drug and alcohol addiction treatment, including allegedly performing medically unnecessary tests, billing for services not performed, and engaging in kickback schemes. The fraudulent claims amount to more than $845 million, according to the DOJ. The defendants include medical providers, owners and operators of substance abuse treatment facilities, and patient recruiters, which evidences the government’s willingness to pursue non-medical providers in healthcare fraud schemes.
Opioid and Traditional Healthcare Fraud Schemes
The DOJ’s historic takedown also ensnared over 240 defendants allegedly involved in schemes to submit more than $800 million to federal and private healthcare payors. The schemes involved illegal opioid distributions, kickbacks, and submission of claims that were medically unnecessary or never performed. Besides the massive takedown, the DOJ noted the collaborative efforts of HHS-OIG, FBI, DEA, 43 U.S. Attorney’s Offices, state agencies, and other unnamed federal enforcement agencies. The DOJ also announced the creation of a new task force, the “National Rapid Response Strike Force,” whose objective is to investigate and prosecute fraud cases involving healthcare providers that operate in multiple jurisdictions. The National Rapid Response Strike Force will join a host investigative teams and task forces, such as the Appalachian Regional Strike Force, the Newark/Philadelphia regional Strike Force, and the Medicare Fraud Strike Force.
Healthcare industry participants (physicians, nurses, licensed medical professionals, and non-providers) must remain vigilant in compliance efforts and with potential fraud and abuse concerns. The government’s collaborations and enforcement actions will continue to increase. “[C]ollaboration is critical in our fight against health care fraud. We will continue working with our law enforcement partners to hold accountable those who steal from federal health programs and protect the millions of beneficiaries who rely on them,” explained the U.S. Department of Health & Human Services’ Deputy Inspector General Gary Cantrell.
The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with government investigations, both criminal and civil, and False Claims Act litigation. If you need assistance with such a matter, please contact us today.