The COVID-19 pandemic caught the nation off-guard, to say the least. Initially, healthcare providers were lauded for their commitment to patient health and wellbeing. And for good reasons, providers selflessly put their own safety on the line to help others. However, as we progress through the pandemic, federal law enforcement agencies are realizing that they may have opened the door to certain types of healthcare fraud during the pandemic.
One of the most aggressively prosecuted types of pandemic-related claims stems from COVID-19 testing fraud; however, there is a broad range of pandemic-related healthcare fraud claims currently under investigation. Indeed, the Department of Justice explains that it is “remaining vigilant in detecting, investigating, and prosecuting wrongdoing related to the crisis.”
Types of COVID-19 Healthcare Fraud Claims
The Department of Justice (DOJ) is committed to rooting out fraud and other illegal activity stemming from vulnerabilities in the system brought about by the COVID-19 pandemic. The DOJ provides some insight as to the types of cases it is currently looking for, which include:
- COVID-19 vaccine fraud
- COVID-19 testing fraud
- Schemes related to COVID-19 stimulus checks
- Unauthorized insurance scams
- Unauthorized and unsubstantiated treatment schemes
DOJ Action Against 14 Healthcare Professionals
Recently, the DOJ announced that it is bringing healthcare fraud charges against 14 providers related to COVID-19 fraud. In total, the DOJ allegations involve more than $143 million in false billing claims. The DOJ claims that these individuals exploited the COVID-19 pandemic for personal profit through various means. While each case presents unique facts, most of them involve one of the following scenarios.
Dr. Nick Oberheiden
Founder
Attorney-at-Law
John W. Sellers
Former Senior Trial Attorney
U.S. Department of Justice
Local Counsel
Joanne Fine DeLena
Former Assistant U.S. Attorney
Local Counsel
Lynette S. Byrd
Former Assistant U.S. Attorney
Partner
Amanda Marshall
Former U.S. Attorney
Local Counsel
Aaron L. Wiley
Former Federal Prosecutor
Local Counsel
Roger Bach
Former Special Agent (OIG)
Gamal Abdel-Hafiz
Former Supervisory Special Agent (FBI)
Chris Quick
Former Special Agent (FBI & IRS-CI)
Kevin M. Sheridan
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Dennis A. Wichern
Former Special Agent-in-Charge (DEA)
Using Patient Information to Perform Unauthorized and Unnecessary Procedures
Several of the defendants in the recently announced cases allegedly used patient information gather through the normal course of treatment to bill Medicare for additional services. For example, in the Western District of Arkansas, providers accessed provider information from prior lab testing orders to submit allegedly fraudulent claims for certain tests, including respiratory pathogen panel and COVID-19 tests. Many of these tests were not performed, and some pertained to patients who had died or never provided a testing sample.
Unauthorized Bundling of Unrelated Procedures
Some providers face allegations that the impermissibly required patients to undergo unrelated testing when obtaining a COVID-19 test. For example, in the Northern District of California, one provider required patients to requested a COVID-19 test to undergo an allergy test that was issued by the same manufacturer. Additionally, the testing kit used was ineffective and was not able to ascertain whether a patient was positive for COVID-19.
Inappropriate Use of COVID-Relief Funds
The federal government provided significant economic stimulus in the form of PPP and EIDL loans. Many healthcare professionals accepted the terms of these loans, which may not necessarily need to be paid back, depending on the circumstances. However, a home healthcare business in the Central District of California faces theft and wire fraud charges related to the misappropriation of funds from the CARES Act Provider Relief Fund. The DOJ also alleges the facility submitted false loan applications and a false loan agreement to the Economic Injury Disaster Loan Program.
Illegal Kickbacks Related to Telehealth Referrals
It quickly became apparent that most in-patient visits were not an option during the COVID-19 pandemic. Thus, “telehealth waivers” allowed providers who may otherwise require an in-person visit to see patients virtually. However, in a case originating out of the Southern District of Florida, two companies now face charges they defrauded the government for engaging in an illegal kickback scheme. Evidently, a consulting company offered a list of Medicare beneficiaries to telehealth providers. The telehealth providers paid kickbacks to the consulting company after billing Medicare for “expensive and medically unnecessary” cancer and cardiovascular genetic testing.
Billing for Services Not Provided
Several practitioners face charges that they used patient information to bill Medicare for services that were never performed. In one case out of the District of New Jersey, a doctor participated in an event advertising COVID-19 testing. However, in addition to authorizing the COVID-19 tests, the doctor allegedly ordered medically unnecessary cancer genetic testing for Medicare beneficiaries who attended the event.
Inappropriate Use of COVID-19 “Emergency Billing Codes”
The owners of several pharmacies in the Eastern District of New York now face health care fraud, wire fraud, and money laundering charges related to the use of COVID-19 emergency billing codes. The pharmacy owners allegedly obtained billing privileges for multiple pharmacies by using nominees to serve as the purported owners and supervising pharmacists. They then used the emergency override codes to get around pre-authorization requirements and limits on the frequency of refills for certain expensive drugs, including Targretin and Panretin.
Contact the Healthcare Fraud Defense Attorneys at Oberheiden, P.C.
If you face allegations of healthcare fraud related to the COVID-19 pandemic, or any other type of claim under the False Claims Act or other federal law, Oberheiden, P.C. can help. We have assembled a dedicated team of attorneys to defend those facing federal healthcare fraud claims, and have particular experience dealing with the issues raised by the pandemic. Many of our lawyers previously supervised the prosecution of fraudulent claims investigations at the U.S. Attorney’s Office and can provide clients with valuable insight. We know how to defeat even the most persuasive complaint. To learn more, reach out to one of our qui tam defense attorneys today at 1-888-680-1745. You can also reach us through our online form, and an attorney will promptly get in touch with you.
Sources:
https://www.justice.gov/coronavirus
https://www.policymed.com/2021/06/doj-turns-its-focus-to-covid-19-fraud.html
https://www.justice.gov/opa/pr/doj-announces-coordinated-law-enforcement-action-combat-health-care-fraud-related-covid-19
