Record Year for Investigators in Healthcare Fraud Cases

The US authorities reportedly opened a record number of cases relating to healthcare fraud in 2020, as unscrupulous individuals tried to profit during the pandemic.

Michael Granston, deputy assistant attorney general at the Department of Justice’s Civil Division, revealed the news during the American Health Law Association’s annual meeting this week, according to Bloomberg Law.

The DoJ opened a total of 900 new cases last year, 580 of which were related to healthcare fraud, according to the report.

The numbers show the scale of the challenge facing private insurers and the US government’s national health insurance program Medicare.

Fraud schemes can take many forms, including staged accidents, billing for services not rendered, unnecessary prescriptions and/or medical devices, and fraudulent use of stolen patient and doctor identities.

Schemes sometimes involve multiple parties, including unscrupulous doctors and clinics. The growth of telemedicine during the pandemic appears to have driven a new surge in fraud, as it’s easier to fake consultations and prescriptions when patients aren’t physically coming into clinics.

In April 2021, a Florida man was sentenced to a decade behind bars for his role in a $3.3 million conspiracy to defraud Medicare by issuing claims for expensive genetic cancer testing that patients didn’t need.

That scheme involved the participation of unscrupulous telemedicine companies and testing laboratories. The former were paid bribes by the guilty man to have doctors authorize the unnecessary tests, while the latter paid him kickbacks for the extra business for their labs.

A separate fraud conspiracy was revealed last year involving former NFL players who submitted millions in claims for expensive medical equipment, including hyperbaric oxygen chambers, that was never purchased or received.

The DoJ claimed earlier this year to have recovered over $2.2 billion in settlements and judgments under the False Claims Act in fiscal year 2020.

According to Granston, the focus for investigators is now on those misusing electronic health records, improperly claiming COVID-19 relief funds, targeting Medicare’s managed care program, defrauding senior citizens and contributing to the opioid epidemic.


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