Gov’t charges 345, revokes billing privileges for 256

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Tuesday, October 13, 2020

WASHINGTON – The Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, has conducted a national “telefraud” takedown involving more than $6 billion in alleged losses. 

The fraudulent activity has resulted in charges for 345 defendants, including telemedicine companies, DME companies, genetic testing labs, pharmacies and more than 100 medical practitioners, in 51 judicial districts. Health care billing privileges have been revoked for 256 medical professionals. 

The biggest loss in connection with the case involved $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts. 

In this case, telemedicine execs allegedly paid medical practitioners to order unnecessary DME, genetic and other diagnostic testing, and medications, either without any patient interaction or with only a brief telephone conversation with patients they had never met or seen. 

Often, the DME, test results or medications were not provided to beneficiaries or were worthless to patients and their primary care doctors and the misdirection, fake diagnosis and unneeded tests misled patients and delayed their chance to seek appropriate treatment for medical complaints, according to the OIG. 

The proceeds of the fraudulent scheme were allegedly laundered through international shell corporations and foreign banks for the benefit of the telemedicine execs. 

The OIG says it has seen an increase in “telefraud” since 2016.