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Criminal Charges Against Individuals Committing Healthcare Fraud

On Behalf of | May 10, 2022 | Fraud

Last week, the Department of Justice announced criminal charges against 21 individuals across the country accused of committing healthcare fraud concerning COVID-19 benefit programs. This was the most significant coordinated COVID-19 bust to date, spanning nine federal districts, and totaling over $149 million in COVID-19 false billings and theft from federal programs. As part of its investigation, the Department seized $8 million in cash and other fraudulent assets. Kevin Polite, the Director of the COVID-19 Fraud Enforcement Division, hinted that this was the first of many investigations. Polite’s comments vowing to “us[e] all available tools to hold accountable medical professionals, corporate executives, and others who have placed greed above care during an unprecedented public health emergency” reflect a sense of urgency and eagerness to prosecute, regardless of the fraud’s size and scope.

The fraud underlying each indictment focuses primarily on Medicare and Medicaid billing practices. Several cases include defendants who received patients’ personal information or blood and saliva samples to submit fraudulent Medicare and Medicaid claims for healthcare services that were neither necessary nor provided. For example, in some cases, the defendants billed for more expensive tests or services to maximize profit. Other defendants used patient information to bill for lengthy office visits, which never occurred.

Similarly, clinical laboratory owners in California were charged with health care fraud and money laundering for billing over $214 million for laboratory tests, of which $124 million involved fraudulent claims. The defendants then laundered the profits through shell corporations. They then transferred the monies to foreign countries to purchase real estate and high-priced luxury goods.

Along with these defendants were post office workers tied up in a fake vaccination card scheme and a Utah man who sold negative preflight coronavirus tests at the Salt Lake City International Airport.

Highlighting the role of medical professionals in carrying out this fraud, Luis Quesada of the FBI’s Criminal Investigative Division called their actions an “ero[sion] [of] [patient] integrity and trust” and vowed to investigate those who “exploit the integrity of the health care industry for profit.”

One such medical professional is a registered nurse in Miami who fraudulently billed more than $134 million in claims to Medicare. As part of the scheme, the nurse signed doctor’s orders for genetic testing and medical equipment and received a kickback under the guise of telehealth consultation fees when no such consultations occurred.

A Maryland medical director faces charges for submitting claims to Medicare for expansive in-office visits when those visits were just a few minutes or for purposes of COVID-19 testing. Such wrongful billing totaled $1.5 million.

With the Federal government’s hyper-focus on COVID-19 fraud and the hiring of 120 prosecutors whose job is to bring these types of cases, the government is hungry to leave no stone unturned. Deeming this “the largest fraud in U.S. history,” these new indictments shed light on what is to come.