86 charged in $4.5B telemedicine fraud scheme: 6 details

The Department of Justice announced charges against several individuals in a scheme to fraudulently bill Medicare and other government payers for telemedicine services on Sept. 30 as part of a larger effort to crack down on healthcare fraud.

Five things to know:

1. The Justice Department alleges 86 individuals were involved in a scheme to use telecommunications technology to provide remote healthcare.

2. Telemedicine executives allegedly paid physicians and nurses to order genetic and diagnostic testing, pain medication and durable medical equipment without proper interaction with patients. Sometimes the clinicians never met the patient, and other times they had brief phone calls before submitting the orders, court documents said.

3. The DME companies, genetic testing labs and pharmacies gave illegal kickbacks and bribes for the orders and then submitted false claims to Medicare and other government payers, according to a statement from the Justice Department.

4. The defendants allegedly submitted $4.5 billion in false and fraudulent claims.

5. On Sept. 30, CMS Center for Program Integrity revoked Medicare billing privileges of 256 medical professionals involved in telemedicine schemes.

6. In addition to the telemedicine charges, the agency also announced charges related to fraudulent billing in connection with addiction treatment and sober homes as well as illegal opioid prescriptions and distribution. Altogether, the Justice Department issued charges against 345 individuals allegedly responsible for $6 billion in alleged fraud on Sept. 30.

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