DOJ announces fraud charges totaling more than $1.2B

The U.S. Department of Justice has announced criminal fraud charges totaling more than $1.2 billion against 36 defendants in 13 federal districts. The allegations include fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment schemes.

“The Department of Justice is committed to prosecuting people who abuse our health care system and exploit telemedicine technologies in fraud and bribery schemes,” says Assistant Attorney General Kenneth A. Polite Jr. of the department’s Criminal Division. “This enforcement action demonstrates that the department will do everything in its power to protect the health care systems our communities rely on from people looking to defraud them for their own personal gain.”

The coordinated federal investigations primarily targeted alleged schemes involving the payment of illegal kickbacks and bribes by laboratory owners and operators in exchange for the referral of patients by medical professionals working with fraudulent telemedicine and digital medical technology companies. Telemedicine schemes account for more than $1 billion of the alleged losses associated with this enforcement action.

These charges include some of the first prosecutions in the nation related to fraudulent cardiovascular genetic testing. As alleged in court documents, medical professionals made referrals for expensive and medically unnecessary cardiovascular and cancer genetic tests, as well as durable medical equipment. For example, cardiovascular genetic testing was not a method of diagnosing whether an individual currently had a cardiac condition and was not approved by Medicare for use as a general screening test for indicating an increased risk of developing cardiovascular conditions in the future.

Read more: Health care fraud dominated DOJ’s false-claims recovery cases last year

One particular case involved the operator of several clinical laboratories, who was charged in connection with a scheme to pay more than $16 million in kickbacks to marketers. The marketers, in turn, paid kickbacks to telemedicine companies and call centers in exchange for doctors’ orders. As alleged in court documents, orders for cardiovascular and cancer genetic testing were used by the defendant and others to submit more than $174 million in false and fraudulent claims to Medicare, but the results of the testing were not used in treatment of patients.

“Protecting the American people is at the forefront of the FBI’s mission,” says Luis Quesada, assistant director of the FBI’s Criminal Investigative Division. “Fraudsters and scammers take advantage of telemedicine and use it as a platform to orchestrate their criminal schemes. This collaborative law enforcement action shows our dedication to investigating and bringing to justice those who look to exploit our U.S. health care system at the expense of patients.”