News: DOJ charges defendants with $4.5 billion in telehealth fraud case

CDI Strategies - Volume 14, Issue 46

The U.S. Department of Justice (DOJ) is charging 345 defendants for submitting more than $6 billion in false and fraudulent claims to federal healthcare programs and private insurers. These false claims include $845 million connected to substance abuse treatment facilities, $806 million connected to illegal opioid distribution, and more than $4.5 billion connected to telehealth.

The $4.5 billion in allegedly false and fraudulent telehealth claims were submitted by more than 86 defendants in 19 social districts.

According to court documents, “certain 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 telephonic conversation with patients they had never met or seen.”

The medical equipment companies, testing laboratories, and pharmacies then purchased said orders in exchange for “illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.”

In addition to these criminal charges, the CMS Center for Program Integrity also announced that it has taken administrative actions related to telehealth fraud by revoking the Medicare billing abilities of 256 additional medical professionals for their involvement in telehealth schemes.

Editor’s note: The DOJ statement on these alleged fraud losses can be found here. To read more about CDI’s role with telehealth, click here.

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