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.