US Prosecutors Line Up Charges in $2.5bn Healthcare Fraud Cases

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The US Justice Department (DoJ) has released details of several wide-ranging cases of alleged healthcare fraud that cost taxpayers billions of dollars.

The first is a sophisticated telemedicine scheme described as one of the largest ever prosecuted, which resulted in the submission of $1.9bn in allegedly fraudulent claims to Medicare and other government insurers for orthotic braces, prescription skin creams and other items.

Read more on healthcare fraud: Man Gets 10 Years for Multimillion-Dollar Medicare Fraud Scheme

First, telemarketers targeted elderly and disabled patients with ads encouraging them to call contact centers where they were upsold unnecessary equipment and prescriptions. The individuals would then have their Medicare coverage verified and be passed to telemedicine companies for doctors to consult and sign off on prescriptions.

The defendants worked for a software company whose tools were allegedly used to generate fake orders for the telemedicine doctors to sign, falsely claiming that the patients had been seen in person and that diagnostic tests had been run.

The original CEO of this company sold it to a new organization which allegedly chose to continue the pre-existing fraud scheme, the DoJ said.

In a separate telemedicine fraud case, a doctor was charged for signing more than 2800 fraudulent orders for orthotic braces, including for patients whose limbs had already been amputated.

Other cases being prosecuted by the DoJ and revealed yesterday include:

  • The owner of a pharmaceutical wholesale company charged in connection with a $150m fraud scheme where they bought expensive HIV medication purchased through an illegal buyback scheme and resold them
  • One individual sentenced to 15 years for one such buyback scheme in which they acquired drugs from patients who had been prescribed but not yet consumed them and then repackaged and sold them to wholesale companies
  • Charges against 24 clinicians who illegally prescribed opioids to patients who didn’t need them. These doctors and healthcare companies paid bribes to patient recruiters and patients in return for information they could submit to Medicare for reimbursement

In total, the DoJ announced charges connected to pharmaceutical fraud in which 10 individuals were charged with submitting over $370m in fraudulent claims linked to prescription drugs.

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