A Spotlight on Recent Notable Medicare Fraud Charges

Well over a year after the first case of COVID-19 reached the West Coast, federal agencies are aggressively responding to allegations of Medicare and health care fraud connected to the pandemic. In fall 2020, the Department of Justice announced what it billed as the largest health care fraud bust in U.S. history. Here are some things we learned from the bust’s related charges and others announced since then.

Telemedicine Fraud

Just as telemedicine and virtual doctor’s visits became more widely used during the COVID-19 pandemic, so did the instances of telemedicine fraud. Last fall, the DOJ announced charges related to $4.5 billion in telemedicine fraud. According to the DOJ, aggressive marketing techniques resulted in gratuitous pain medicine, genetic testing, and durable medical equipment orders. Certain medical supplies purchased these fraudulent orders in exchange for kickbacks.

The alleged schemes ensnared telehealth executives, doctors, nurse practitioners, and various personnel working at laboratories and pharmacies. The Centers for Medicare and Medicaid Services announced that it was looking closely at 256 individuals in connection with alleged Medicaid and Medicare fraud.

Clinical Research Fraud

The Miami area, in particular, has seen a handful of criminal charges and guilty pleas of doctors and medical personnel involved in research trials. In mid-May, a former study coordinator was charged with fraud. The DOJ alleged that she falsified numerous records related to asthma medication for children. Federal agencies take clinical research fraud seriously, as incorrect data could lead to improper approval of medication by the FDA.

Looking Ahead

By no means are the criminal charges for telehealth fraud over with. Experts anticipate Medicare fraud charges to continue piling up for opioid prescribers, as well. Keep an eye out for the current case in West Virginia against three large opioid distributors.

Whatever the nature of your Medicare fraud charges, quality legal counsel is crucial. Attorney Barry M. Wax has decades of experience in federal court and is prepared to provide you with an aggressive defense. Contact the firm today to set up your free consultation.