Unprecedented Healthcare Fraud Schemes Exposed: A Glimpse into the Recent DOJ Crackdown
In a groundbreaking move, the Department of Justice has unveiled criminal charges against 18 defendants across nine federal districts in the U.S., exposing their alleged involvement in fraudulent schemes related to healthcare services exploiting the COVID-19 pandemic. These schemes are said to have resulted in over $490 million in false billings to federal programs and theft from federally funded pandemic initiatives.
These recent charges have shed light on the emphasis that the DOJ is taking on healthcare fraud crimes in the United States. If you’re facing healthcare fraud charges, do not delay. You must speak with an experienced federal healthcare fraud defense attorney as soon as possible to begin building the best possible defense for your case. Contact Sosinsky Law now at (212) 285-2270 for a free consultation and to learn more about how we can help.
The Central District of California played a central role in two significant cases, revealing the extent of exploitation within the healthcare sector. In one case, a medical doctor, Dr. Anthony Hao Dinh, is charged with orchestrating a $230 million fraud on the Health Resources and Services Administration’s COVID-19 Uninsured Program. Dr. Dinh, the second-highest biller nationally for the program, allegedly submitted fraudulent claims, billed for services not rendered, and billed for medically unnecessary services. The doctor is also accused of diverting the fraud proceeds into high-risk options trading, resulting in significant losses.
In another case from the Central District of California, a lab owner, Lourdes Navarro, faces charges for submitting over $358 million in false claims to Medicare, HRSA, and a private insurance company. The lab allegedly added fraudulent claims for respiratory pathogen panel tests, exploiting vulnerable populations in nursing homes and schools.
The charges extend beyond healthcare providers to include suppliers of COVID-19 over-the-counter tests and individuals involved in manufacturing and distributing fake vaccination record cards. In one instance, a doctor and marketer from the Middle District of Florida face charges for unlawfully purchasing Medicare beneficiary identification numbers and submitting over $8.4 million in fraudulent claims.
The announcement emphasizes the Department’s commitment to combating pandemic-related fraud and protecting taxpayer-funded programs. Attorney General Merrick B. Garland stated, “The Justice Department will not tolerate those who exploited the pandemic for personal gain and stole taxpayer dollars.”
This enforcement action builds upon previous efforts in April 2022 and May 2021 and involves the prosecution of various COVID-19 healthcare fraud schemes. The cases span multiple federal districts and reveal the comprehensive nature of the DOJ’s crackdown on fraudulent activities related to the pandemic.
The charges against these defendants involve a range of offenses, including healthcare fraud, wire fraud, money laundering, making false statements, and more. The legal proceedings are being led by various federal agencies, including the U.S. Department of Health and Human Services Office of the Inspector General, the FBI, the IRS Criminal Investigation, and the Department of Homeland Security, among others.
Recent Enforcement Actions & Areas to Watch
The Department of Justice (DOJ) has recently intensified its scrutiny of telemedicine, taking legal action against individuals accused of engaging in telemarketing schemes involving clinical laboratory testing or durable medical equipment companies. In their enforcement efforts in 2022, the DOJ filed charges against 36 defendants for an alleged fraud amounting to over $1.2 billion, resulting in the recovery of $8 million. These cases involve allegations of utilizing telemedicine to offer beneficiaries low-cost or free products or testing, subsequently selling these items to medical equipment companies or laboratories in exchange for kickbacks to the telemedicine company.
In June 2023, the DOJ announced a coordinated and extensive healthcare enforcement initiative, charging 78 individuals with alleged fraud and abuse totaling $2.5 billion. This comprehensive enforcement action addressed various areas susceptible to fraud and abuse, ranging from telemedicine fraud to pharmaceutical fraud and opioid distribution.
There Are Defenses to Federal Healthcare Fraud
Firstly, a crucial factor in most criminal healthcare fraud prosecutions is the presence of “fraudulent intent” on the part of the accused. If it can be demonstrated that the accused acted in good faith, even if their belief was incorrect, then the element of fraudulent intent may be lacking. Similarly, a defense of a mistake, such as an unintentional misstatement, representation, or omission, may be put forth. If the prosecution is based on allegations of overbilling or the submission of incorrect billing codes, it is plausible that clerical errors made by the accused or an employee of the office might have resulted in these erroneous claims. After all, billing codes in CRT are intricate and constantly evolving.
Secondly, in prosecutions centered around the notion of billing for medically unnecessary procedures or prescriptions, it is possible to establish the medical appropriateness of the disputed conduct by collaborating with one or more experts in medicine and billing. By challenging the prosecution’s experts regarding the claimed standard of care, it can be demonstrated that there was no intent to defraud.
Thirdly, in numerous healthcare fraud prosecutions, a viable defense may be raised, asserting that the accused was uninvolved and unaware of another person’s fraudulent activities. In many clinics and medical offices, there may not be a clear delineation of the individual(s) responsible for medical billing, and different employees within the office may perform different aspects of the billing process. Without clear evidence regarding the actions of each individual, it may be challenging to identify those accountable for the fraudulent submission of claims. Additionally, contradictory evidence may arise regarding whether the staff was billing based on their own expertise or whether they were following specific instructions from a provider.
Fighting Pandemic Exploitation: Department of Justice’s Relentless Pursuit of Justice
As the legal battles unfold, the Department of Justice continues its relentless pursuit of those seeking to exploit the pandemic for personal gain, sending a clear message that fraudsters will be held accountable. The collaborative effort between federal agencies reflects a commitment to safeguarding the integrity of taxpayer-funded programs and maintaining public trust in healthcare services during these challenging times.
For more information on the Department’s response to pandemic-related fraud, visit www.justice.gov/coronavirus