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Justice Department launches fraud initiative tied to COVID-19 care

On Behalf of | May 5, 2023 | Healthcare Fraud, Medicare / Medicaid Fraud

The Department of Justice announced a new coordinated enforcement action to fight COVID-19 healthcare fraud. The targets will include owners of medical businesses, medical professionals and others who attempted various schemes. The DOJ estimates that $490 million were stolen from federal programs created to combat the pandemic using false billing and outright theft.

Actions already underway

Announced in April of 2023, the new action has already seized $16 million in cash and proceeds. The Center for Program Integrity at the Centers for Medicare and Medicaid Services already took administrative action in 2022 against 28 medical providers for participating in COVID-related scams.

The DOJ’s announcement regarding the coordinated effort was also related to new charges brought against several defendants for defrauding the Health Resources and Services Administration’s COVID-19 Uninsured Program, which was created to prevent the further spread of the pandemic by enabling uninsured patients to get free testing and treatment.

One notable case involved $358 million in false and fraudulent laboratory testing claims filed by a medical lab in California. The claims were submitted to Medicare, Health Resources Services Administration and private carriers, claiming they were tests for elder care facilities as well as primary and secondary schools. The provider increased the cost of the claims by allegedly adding respiratory pathogen panel tests even if the providers or facility did not order the test.

They have also caught a California doctor who orchestrated fraudulent billing totaling $230 million to the Uninsured Program. The doctor was the Uninsured Program’s second-highest biller in the country. He has already admitted that he fraudulently billed the program despite many patients having insurance or for services not provided to patients.

Another targeted action included suppliers of over-the-counter COVID tests, which Medicare began to cover in 2022, to beneficiaries who requested them. Scammers reportedly purchased Medicare beneficiary identification numbers to provide unwanted or unneeded tests (the unneeded ones were for deceased recipients). These illegal actions led $8.4 million in fraudulent charges to Medicare.

Largest action of its kind

According to the Justice Department, this new action will be the largest coordinated action of its kind, following up on the success of the DOJ’s COVID-Enforcement actions in 2021 and 2022. The Justice Department’s Criminal Division’s Health Care Fraud Unit will again oversee the efforts and coordinate with the FBI and the U.S. Attorney General’s Office.