News: $1.2 billion in healthcare fraud tied to telehealth and cardiovascular tests

CDI Strategies - Volume 16, Issue 30

Alleged fraudulent billing schemes were charged against 36 defendants at an estimated $1.2 billion, according to Medscape Medical News. The fraud was tied to telemedicine, genetic and cardiovascular testing, and equipment, targeting clinical laboratory owners, marketers, medical professionals, and telemedicine executives. The schemes intended to swindle Medicare out of $1.2 billion but actual losses are closer to $440 million, prosecutors for the United States Justice Department said.

"The cases announced today include charges against people who brazenly used Medicare funds to purchase luxury items, medical professionals who corruptly approved testing and equipment, and business owners who submitted false and fraudulent claims for services patients did not need," Kenneth Polite, the head of the department's criminal division, told Medscape.

The alleged fraud schemes involved well-known billing and kick-back practices that target the Medicare program, as well as a new fraudulent practice that takes advantage of patients’ fear of cardiovascular disease by convincing them to take medically unnecessary screening tests. Billing for such tests has spiked over the last year, and sometimes for as much as $10,000 per test. The total amount billed was $748 million, of which $223 million was paid.

Telemedicine has played a role in such schemes before on a smaller scale. But now that some telehealth services are permanent for Medicare, and especially as United States regulators have relaxed certain rules to make it more accessible, its use has expanded in billing fraud. CMS also took parallel administrative action with the department against 52 companies involved in similar schemes.

Editor’s note: You can read Medscape Medical News’ coverage of this story here. For more telemedicine news, click here.

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