More than 100 physicians, nurses and other medical professionals have been charged in relation to schemes that defrauded federal healthcare programs and private insurers by more than $6 billion, according to a Sept. 30 news release from the Department of Justice.
A total of 345 defendants have been accused of submitting fraudulent claims worth more than $4.5 billion connected to telemedicine, over $845 million tied to substance abuse treatment facilities, and more than $806 million linked to other healthcare fraud and illegal opioid distribution schemes.
As part of the largest healthcare opioid and fraud case in the DOJ's history, certain telemedicine executives allegedly paid physicians and nurse practitioners to order unnecessary medical equipment, tests and pain medications, either without any patient interaction or only brief phone conversations. Medical equipment companies, testing labs and pharmacies then purchased those orders in exchange for illegal kickbacks and submitted fraudulent claims to insurers, according to the DOJ.
Physicians, patient recruiters, owners and/or operators at substance abuse treatment facilities allegedly paid illegal kickbacks for the referral of patients; those patients were subjected to medically unnecessary drug testing and therapy sessions that were often not provided and resulted in false and fraudulent claims being submitted to private insurers, the DOJ said. Medical professionals also allegedly prescribed unnecessary medications, sometimes to entice patients to stay at the facility. Patients were then often discharged and admitted to other treatment facilities, labs or clinics in exchange for more kickbacks.
More than 240 defendants are accused of submitting over $800 million in false and fraudulent claims to Medicare, Medicaid, Tricare and private insurance companies for treatments that were unnecessary and often never provided. Also included are medical professionals accused of distributing more than 30 million doses of opioids and other prescription narcotics.