Justice Department charges 138 people with health care fraud incurring $1.4 billion in losses

The Justice Department announced Friday that it’s charging 138 people for their involvement in telemedicine schemes and other health care fraud across the country that may have incurred over $1.4 billion in losses.

Telemedicine, opioid prescriptions, patient information, federally-allocated provider reliefs funds and sober home initiatives were abused and used to illegally profit from health care charges and reimbursements, the Justice Department alleges. Many of the crimes targeted in the takedowns focused on components of the health care system that have been put under even greater stress during the COVID-19 pandemic.

According to the Justice Department, 43 criminal defendants across 11 jurisdictions are charged with telemedicine schemes amounting to a whopping $1.1 billion in alleged losses.

Citing court documents, the department said, “[T]elemedicine 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 telephonic conversation with patients they had never met or seen.” Medical equipment companies and genetic testing labs then allegedly fulfilled the orders in exchange for kickbacks and bribes.

In one example alone, Assistant Attorney General Kenneth Polite Jr. described an alleged criminal act in which the New Jersey defendants used telemedicine to submit over $784 million in false medical bills to Medicare.

Nineteen defendants, including 10 physicians, are accused of illegally prescribing 12 million doses of opioids and other narcotics and subsequently submitting $14 million in false billings. Assistant Attorney General Kenneth Police noted opioid deaths have increased 30% in the last year, and he tied them to these alleged actions, telling reporters, “Behind every loss to addiction are families and friend who mourn and communities who suffer…The Department of Justice will aggressively prosecute anyone who illegally peddles opioids for profit.”

Nine additional defendants have been charged with engaging in health care fraud schemes “designed to exploit the COVID-19 pandemic” that yielded over $29 million in fake billings. They’re accused of taking advantage of Medicare’s expansion and leniency during the health emergency by submitting claims for pricey and unnecessary tests.

In all, 25 U.S. attorney’s offices are prosecuting the cases across 31 federal districts.