On April 20, 2022, the Department of Justice (DOJ) announced criminal charges against 21 defendants in nine federal districts stemming from their alleged involvement in various healthcare fraud schemes related to the COVID-19 pandemic. The alleged conduct resulted in about $149 million worth of false billings to federal programs and theft from federally-funded pandemic assistance programs. Following a hiatus during the height of the COVID-19 pandemic, Medicare and other audits have resumed in full force with a focus on pandemic-related healthcare activity. The Department of Health and Human Services (HHS) has also announced additional audits of certain healthcare providers that received funding from the Provider Relief Fund (PRF). HHS and the federal government have long promised “significant enforcement” related to COVID-19 healthcare activity, which is a promise that appears to be materializing.
In one instance, a Tennessee provider has been charged with theft of government property in connection with an alleged scheme to unlawfully convert PRF funds. The individual is a former owner and operator of a hospice care center that received PRF funds for which investigators claim it did not qualifiy. As alleged, rather than returning the incorrectly deposited funds, the individual used the name of another, deceased owner of the hospice center in order to falsely attest to the PRF terms and conditions that the funds would be used for pandemic-related expenses. The individual allegedly used the funds to write a check to himself and make a payment on one of his other company’s credit card accounts.
Another case involves a Maryland provider charged with multiple counts of healthcare fraud from an alleged scheme to defraud the United States of more than $1.5 million in claims billed in relation to COVID-19 testing. The individual is an owner of an urgent care facility who allegedly instructed employees to submit claims to Medicare and other insurers for moderate-complexity office visits even though some or all of those visits for COVID-19 testing lasted only a few minutes.
In yet another case, a Florida registered nurse practitioner has been charged with healthcare fraud stemming from exploitations of policies that the Centers for Medicare and Medicaid Services (CMS) put in place to enable increased access to care during the pandemic. The individual allegedly exploited the COVID-19 telemedicine waivers by signing a large volume of physician’s orders for medically unnecessary genetic testing and durable medical equipment in exchange for kickbacks. Those kickbacks were in the form of sham telehealth consultation fees and the opportunity to bill Medicare, under the telemedicine waivers, for telemedicine consultations that the individual allegedly did not perform.
In light of the increased federal enforcement activity targeting COVID-19 related healthcare fraud, providers should ensure their practices are in compliance with the terms and conditions of the PRF and the various pandemic relief programs and waivers.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters. If you or your healthcare entity has any questions pertaining to the PRF or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or email@example.com.