For the last few years, we have been closely monitoring and reporting on COVID-19 related fraud enforcement efforts by federal agencies. We detailed those findings in our Health Care Enforcement 2020 Year in Review & 2021 Outlook (2020 Year in Review) and 2021 Year in Review & 2022 Outlook (2021 Year in Review).
In the 2021 Year in Review, we reported on Attorney General Merrick Garland's May 2021 announcement of the creation of an interagency COVID-19 Fraud Enforcement Task Force and we also detailed two major takedowns executed by this Task Force in May and September 2021. In addition, we covered a number of the substantive areas toward which federal enforcement authorities had turned their focus in 2021, including fraud against the Provider Relief Fund and fraud related to the provision of COVID-19 related health care services, among others.
Last week, the Department of Justice (DOJ) announced another significant takedown that it described as “build[ing] on the success of the May 2021 COVID-19 Enforcement Action.” As part of this enforcement effort, criminal charges were announced against 21 defendants across the country for their alleged involvement in various COVID-19 related fraud schemes that resulted in over $149 million in “COVID-19 related false billings to federal programs and theft from federally-funded pandemic assistance programs.”
Generally speaking, the alleged schemes at issue in this takedown were very similar to the enforcement actions that we reported on in our 2021 Year in Review:
- Misuse of patient information and specimens received through COVID-19 testing to submit false claims to Medicare for unrelated, medically unnecessary, and far more expensive services – or for services that were never actually provided.
- Exploitation of telehealth policies that the Centers for Medicare & Medicaid Services (CMS) had relaxed during the pandemic to improve access to care by billing of federal health care programs for telemedicine visits that never occurred and ordering unnecessary genetic testing in exchange for access to telehealth patients.
- Misappropriation of COVID-19 relief funds issued through the Provider Relief Fund (which provides financial assistance to medical providers caring for COVID-19 patients).
- Selling of fake COVID-19 vaccines and falsification COVID-19 vaccination records.
We also highlighted in the 2021 Year in Review that interagency cooperation and a focus on individual wrongdoers were hallmarks of COVID-19 related fraud enforcement. This most recent enforcement action was another example of both trends. The DOJ press release on this takedown credits several strike forces and U.S. Attorneys’ Offices across the country with prosecuting the many cases included in this announcement and also notes the involvement of 11 different federal agencies in this enforcement effort. These agencies included the Federal Bureau of Investigation, the OIG, and CMS, as well as the Offices of Inspector General to several federal agencies including the U.S. Postal Service, the Department of Defense, the Department of the Interior, the Department of Labor, and the Food and Drug Administration, among others. With respect to individual liability, this most recent enforcement action - like previous actions - targeted individual business owners (e.g., the owners of laboratories accused of misusing patient information to bill for unnecessary services) and health care providers (e.g., medical professionals billing for sham telemedicine encounters, selling fake vaccines, and falsifying vaccine cards).
Stay tuned for future updates.