A press release issued by the Department of Justice on Wednesday detailed charges brought against 36 defendants that allegedly participated in telemedicine, clinic laboratory, and durable medical equipment (DME) fraud. The charges are a part of a law enforcement effort coordinated nationwide.
The criminal charges were brought against 36 separate defendants in 13 federal districts across the country. The defendants charged included a telemedicine company executive, the owners and executives of clinical laboratories, DME companies, marketing organizations, and medical professionals. The charges totaled over $1.2 billion and alleged that the defendants were specifically involved in telemedicine fraud, cardiovascular and cancer genetic testing fraud, and DME fraud.
The Centers for Medicare & Medicaid Services (CMS) and Center for Program Integrity (CPI) also announced action they took against 52 providers who were also allegedly involved in fraud.
One of the defendants who was a subject of the charges allegedly participated in a scheme that involved “the payment of illegal kickbacks and bribes by laboratory owners and operators in exchange for the referral of patients by medical professionals working with fraudulent telemedicine and digital medical technology companies.” The medical professionals cited in the charges reportedly made referrals for medically unnecessary cardiovascular and cancer genetic tests as well as DME. Clinical laboratories paid kickbacks to marketers who paid kickbacks to telemedicine companies in exchange for doctor’s orders, which ultimately resulted in false and fraudulent claims being submitted to Medicare.
The complaint explained that the proceeds of the defendant’s schemes were laundered through “a complex network of bank accounts and entities, including to purchase luxury vehicles, a yacht, and real estate.”
Another one of the defendants was accused of controlling a telemarketing network that would lure elderly and disabled patients who were Medicare beneficiaries to agree to unnecessary testing. Further, the complaint contends that expensive genetic tests were ordered by the defendants “regardless of whether the patients needed them, and… they were ordered without any patient interaction or with only a brief telephonic conversation.”
Assistant Attorney General Kenneth A. Polite Jr. said of the charges, “The Department of Justice is committed to prosecuting people who abuse our healthcare system and exploit telemedicine technologies in fraud and bribery schemes. This enforcement action demonstrates that the department will do everything in its power to protect the health care systems our communities rely on from people looking to defraud them for their own personal gain
