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DOJ accuses telemedicine operation of health care fraud

The Department of Justice (DOJ) recently released the indictment for four men and seven companies the agency has accused of involvement in a billion-dollar health care fraud scheme. The accusations include conspiracy to commit health care fraud, mail fraud and introduction of misbranded drugs into interstate commerce and result in 32 criminal charges.

According to the DOJ, these individuals and companies deceived tens of thousands of patients and over 100 medical professionals with an elaborate telemedicine scheme that provided prescriptions that were allegedly “massively” overpriced for a three-year period of time spanning from 2015 to 2018. The indictment states the accused submitted a minimum of $931,000,000 in fraudulent claims during this time period.

The scheme allegedly involved fraudulent solicitation of insurance coverage information for prescription pain creams and similar medications. Ultimately, the government states the accused ran an operation that resulted in physicians approving prescriptions for invalidly prescribed and overpriced drugs. The patient would then submit a claim for insurance to pay for the prescription to pay the accused, thus completing the scheme.

The allegations come with serious penalties. If convicted, the individuals could face:

  • Jail time. Although the exact sentence will depend on a number of factors, each of the individuals accused faces up to two decades imprisonment for each mail fraud charge as well as an additional 10 years for conspiracy and three years’ imprisonment for introducing misbranded drugs into interstate commerce.
  • Fines. Each could face up to $250,000 in fines as well as forfeiture of $154,000,000 in assets.
  • Supervised release. The court could also add an additional three years of supervised release for each conviction.

Such penalties are not uncommon. Any professional facing allegations of health care fraud is wise to take the accusations seriously. An attorney experienced in representation during an investigation by the federal government can help protect your rights.