The Acting Assistant Attorney General of the Justice Department’s Criminal Division recently announced a “historic nationwide enforcement action” that resulted in criminal charges for over 100 doctors, nurses and other medical professionals. The charges are the result of allegations the professionals submitted over $6 billion in false and fraudulent claims.
What led to the charges?
Department of Justice (DOJ) officials state that medical professionals filed over $4.5 billion of these false and fraudulent claims for telemedicine services. The government states the accused ordered unnecessary medical equipment, testing and pain medications after brief phone conversations with patients – or no conversation at all. The health care professionals involved in these alleged scams would then receive kickbacks for the order.
In addition to telemedicine violations, the DOJ also accused a group of health care professionals of making false claims for tests and treatments for patients seeking treatment for drug and/or alcohol abuse. The DOJ claims medical professionals paid bribes for patient referrals and then ordered medically unnecessary drug testing for those patients. In some cases, the government claims Medicare or private insurance companies were billed thousands for completion of a single test.
What should health care professionals learn from this announcement?
Officials were clear when they announced the charges: they are continuing to pursue false and fraudulent charges even during the pandemic. Representatives stated health care professionals should have “no doubt” that the department will continue to investigate allegations of wrongdoing. Those who are the subject of such an investigation can lose their medical licensure and may no longer receive Medicare reimbursement payments. If the investigation results in criminal charges, the physicians, nurses and other medical professionals could face harsh financial penalties as well as imprisonment.