US announces $1.2 billion health care crackdown linked to telehealth and cardiovascular testing

By Sarah N. Lynch

WASHINGTON, July 20 (Reuters)The US Department of Justice unveiled a $1.2 billion healthcare fraud crackdown on Wednesday, revealing criminal charges against 36 defendants over alleged fraudulent billing schemes related to telemedicine, testing genetics and cardiovascular and equipment.

The criminal charges, which were uncovered in 13 federal districts between July 11 and July 20, target clinical lab owners, marketers, medical professionals and telemedicine executives.

Prosecutors said the schemes were intended to defraud Medicare of $1.2 billion, though the actual losses were closer to $440 million.

“The Department of Justice is committed to prosecuting those who abuse our healthcare system and exploit telemedicine technologies in fraud and corruption schemes,” said Kenneth Polite, who heads the department’s criminal division.

Separately, the Center for Medicare Services, part of the US Department of Health and Human Services, has taken parallel administrative action against 52 companies involved in similar programs.

The alleged fraud schemes relate to both older, well-known billing and kickback practices that target the Medicare program, as well as a burgeoning new fraudulent practice of “preying on the patients’ fear of cardiovascular disease” by urging them to submit to medically unnecessary cardiovascular disease screening, a Justice Ministry official told Reuters in an interview on Tuesday.

Billings for these cardiovascular tests have increased over the past year, Justice Department officials added, noting that some of these tests are billed up to $10,000 each, with claims sometimes paying as much as $8. 000 dollars.

Before the pandemic, investigators focused on billing schemes for unnecessary purchases of durable medical equipment such as crutches and walkers, as well as genetic testing to determine risks of developing hereditary cancers.

In a 2019 special report, Reuters reported that the United States was investigating more than 300 issues involving genetic testing programs, in which older people were asked to provide a cheek swab to determine their risk of developing cancer.

The tests were ordered by doctors who, in many cases, had no medical connection to the patients and sent to laboratories. The tests were then billed to Medicare.

One of the labs featured in the report was later raided by federal agents, part of the government’s crackdown on genetic testing fraud in a takedown dubbed Operation Double Helix.

Although telemedicine has played a role in past fraud schemes, its use has grown significantly since the pandemic as US regulators have relaxed some rules to make telemedicine more accessible to patients.

Justice Department officials estimate that the focus on telemedicine has saved the Medicare program nearly $2 billion.

(Reporting by Sarah N. Lynch; Editing by Scott Malone and Richard Pullin)

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