Eighteen defendants in nine federal districts across the United States face criminal charges for their alleged participation in various fraud schemes involving health care services that the Justice Department alleges exploited the COVID-19 pandemic to falsely bill more than $490 million to federal programs and theft from federally funded pandemic programs.
In connection with the enforcement action, announced by the Justice Department today, the Justice Department reports seizing more than $16 million in cash and other fraud proceeds.
Meanwhile, the Center for Program Integrity of the Centers for Medicare & Medicaid Services (CPI/CMS) separately announced today that it took adverse administrative actions in the last year against 28 medical providers for their alleged involvement in COVID-19 schemes.
Comments from Justice Department and other agency leaders made in connection with their announcement of the charges warn other health industry organizations and other COVID-19 program participants to assess and redress their own potential exposures for COVID-19-related billing abuses.
Variety Of Abuses & Charges
The allegations and resulting charges against the 18 defendants vary. One of the most significant types of COVID-19 health care fraud schemes announced today, multiple defendants were charged with defrauding the Health Resources and Services Administration (HRSA) COVID-19 Uninsured Program. The Uninsured Program was designed to prevent the further spread of the pandemic by providing access to uninsured patients for testing and treatment. The Uninsured Program was also designed to provide financial support to health care providers fighting the COVID-19 pandemic by reimbursing them for services provided to uninsured individuals. The Uninsured Program ultimately ceased operating due to the exhaustion of funding.
In the Central District of California, a lab owner was charged for allegedly submitting over $358 million in false and fraudulent claims to Medicare, HRSA, and a private insurance company for laboratory testing. The indictment alleges that the defendant’s lab performed COVID-19 screening testing for nursing homes and other facilities with vulnerable elderly populations, as well as primary and secondary schools. But to increase its reimbursements, the defendant allegedly fraudulently added claims for respiratory pathogen panel tests even though ordering providers and facility administrators did not want or need them.
Also in the Central District of California, a medical doctor was charged for allegedly orchestrating an approximately $230 million fraud on the Uninsured Program. The doctor was the second highest biller in the country to the Uninsured Program, and he allegedly submitted fraudulent claims for the treatment of patients who were insured, billed for services that were not rendered, and billed for services that were not medically necessary. He allegedly used over $100 million in fraud proceeds for high-risk options trading. The doctor is also charged with two other individuals for allegedly submitting over 70 fraudulent loan applications through the Paycheck Protection Program (PPP) and Economic Injury Disaster Loan (EIDL) Program and fraudulently obtaining over $3 million in loan funds.
Charges also were brought under the Health Care Fraud Unit’s Provider Relief Fund (PRF) Initiative. The PRF is part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, a federal law enacted in March 2020 that provided financial assistance to medical providers to deliver needed medical care to Americans suffering from COVID-19. In the Eastern District of Louisiana, the operator of a primary care clinic and purported spa was charged with allegedly submitting fraudulent loan agreements, attestations, and other documentation from which she received over $1.1 million in PRF and EIDL funds that were used to purchase real estate, luxury vehicles, a boat, a trailer, a timeshare, and luxury vacations, among other expenditures. In total, 12 defendants have been charged with crimes related to misappropriating funds intended for frontline medical providers, and seven have pleaded guilty.
The law enforcement action also includes charges against manufacturers and distributors of fake COVID-19 vaccination record cards, who intentionally sought to obstruct the Department of Health and Human Services (HHS) and Centers for Disease Control and Prevention (CDC) in their efforts to administer the nationwide vaccination program and provide Americans with accurate proof of vaccination.
In the Eastern District of New York, three medical professionals who worked at a small midwife practice were charged for allegedly distributing nearly 2,700 forged COVID-19 vaccination record cards to individuals who were not vaccinated. Instead of administering the COVID-19 vaccine, the defendants allegedly destroyed vials of COVID-19 vaccines that were intended to be used to inoculate patients. Despite being a small midwife practice, it was one of the busiest vaccination sites in New York State, outpacing large, state-run vaccination sites.
In the District of Utah, two individuals were charged for allegedly manufacturing and selling online approximately 120,000 counterfeit COVID-19 vaccination record cards across the country, especially in areas that were subject to more stringent COVID-19 vaccine restrictions.
The announcement also includes first-of-their-kind charges against suppliers of COVID-19 over-the-counter tests, which Medicare began to cover in April 2022 for beneficiaries who requested them. These kits were provided to the public to slow the spread of the deadly disease, but wrongdoers allegedly sought to exploit the program by repeatedly supplying patients or, in some instances, deceased patients, with dozens of COVID-19 tests that they did not want or need. In the Middle District of Florida, a doctor and a marketer were charged for allegedly unlawfully purchasing Medicare beneficiary identification numbers and shipping over-the-counter tests to beneficiaries throughout the country who did not request the tests, causing over $8.4 million in fraudulent claims to Medicare.
Task Force Targets COVID-19-Related Fraud
The enforcement actions build on the successes of the April 2022 COVID-19 Enforcement Action and the May 2021 COVID-19 Enforcement Action and mark the largest-ever coordinated law enforcement action in the United States targeting health care fraud schemes that exploit the COVID-19 pandemic.
On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across the government to enhance efforts to combat and prevent pandemic-related fraud. The Task Force bolsters efforts to investigate and prosecute the most culpable domestic and international criminal actors and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts.
In the past three years, the Health Care Fraud Strike Force reports having charged 53 defendants in nationwide COVID-19 Health Care Fraud Enforcement Actions for causing over $784 million in loss associated with the pandemic, and 20 defendants have been convicted.
The charges brought today resulted from coordinated investigations by a host of agencies including the Justice Department, FBI, HHS-OIG, Small Business Administration, Office of Inspector General, Defense Criminal Investigative Service, Internal Revenue Service Criminal Investigation, Treasury Inspector General for Tax Administration, Homeland Security Investigations, Department of Homeland Security Office of Inspector General; Department of Defense Office of Inspector General, AMTRAK Office of Inspector General, California Department of Health Care Services, and other federal and state law enforcement agencies participated in the law enforcement action.
More enforcement is likely. Attorney General Merrick B. Garland warned, “This unprecedented enforcement action against defendants across the country makes clear that the Department is using every available resource to combat and prevent COVID-19 related fraud and safeguard the integrity of taxpayer-funded programs.”
“Exploiting the COVID-19 pandemic and viewing the public health emergency as an opportunity to steal money and resources from federal health care programs shows a clear disregard for the well-being and safety of those who rely on government-funded health care services,” said Inspector General Christi A. Grimm of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “As today’s enforcement action demonstrates, HHS-OIG and our partners remain steadfast in our commitment to protecting critical public health measures from fraud.”
In the face of these enforcement activities, healthcare organizations, and others that billed for or received funds for COVID-19-related care or other programs are urged to carefully review and monitor the compliance of those activities in light of guidance and enforcement activities, and to take appropriate responsive action to mitigate any exposure from questionable activities.
When assessing risks, health care and other providers of COVID-19-related care or other services should be cognizant that guidance and interpretations regarding the appropriate utilization and billing for these programs has and continues to evolve.
To mitigate risk, many organizations will want to capture and retain not only the documentation regarding their original basis for understanding as well as their efforts to monitor, evolving, developments, and respond accordingly.
Program participants also should keep in mind that alleged violations can carry substantial, civil and criminal charges. In light of the potential risks, most organizations will want to conduct their assessments with the assistance of qualified legal counsel and use appropriate processes to conduct and protect sensitive work and discussions with attorney-client privilege where possible.
We hope this update is helpful. For more information about these or other health or other legal, management or public policy developments, please contact the author Cynthia Marcotte Stamer via e-mail or via telephone at (214) 452 -8297.
Solutions Law Press, Inc. invites you to receive future updates by registering on our Solutions Law Press, Inc. Website and participating and contributing to the discussions in our Solutions Law Press, Inc. LinkedIn SLP Health Care Risk Management & Operations Group, HR & Benefits Update Compliance Group, and/or Coalition for Responsible Health Care Policy.
About the Author
Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for 35 plus years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications.
A Fellow in the American College of Employee Benefit Counsel, Chair of the American Bar Association (“ABA”) International Section Life Sciences and Health Committee, Chair-Elect of the ABA TIPS Section Medicine & Law Committee, Past Chair of the ABA Managed Care & Insurance Interest Group, Scribe for the ABA JCEB Annual Agency Meeting with HHS-OCR, past chair of the ABA RPTE Employee Benefits & Other Compensation Group and current co-Chair of its Welfare Benefit Committee, Ms. Stamer is most widely recognized for her decades of pragmatic, leading-edge work, scholarship and thought leadership on health and managed care and employer benefits legal, public policy and operational concerns in the healthcare, employer benefits, and insurance and financial services industries. She speaks and publishes extensively on HIPAA and other related compliance issues.
Ms. Stamer’s work throughout her career has focused heavily on working with health care and managed care, health and other employee benefit plan, insurance and financial services and other public and private organizations and their technology, data, and other service providers and advisors domestically and internationally with legal and operational compliance and risk management, performance and workforce management, regulatory and public policy and other legal and operational concerns.
For more information about Ms. Stamer or her health industry and other experience and involvements, see www.cynthiastamer.com or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
About Solutions Law Press, Inc.™
Solutions Law Press, Inc.™ provides human resources and employee benefit and other business risk management, legal compliance, management effectiveness and other coaching, tools and other resources, training and education on leadership, governance, human resources, employee benefits, data security and privacy, insurance, health care and other key compliance, risk management, internal controls and operational concerns. If you find this of interest, you also be interested in reviewing some of our other Solutions Law Press, Inc.™ resources available here such as:
- Medical Professionals, Medical Businesses Owners and Others Criminally Charged In $490 Million Plus COVID-19 Related False Billings Takedown
- Sibley Hospital & Johns Hopkins Health System Pay $5 Million To Settle Stark Violations
- HHS Inspector General Comments Signal MorrContinuAggressive Ahgh￼inued Aggresdiv
- 4/21 Deadline For Comments On Proposed HIPAA Administrative Simplification Adoption of Standards for Health Care Attachments Transactions and Electronic Signatures, and Modification To Referral Certification and Authorization Transaction Standard
- Pharmaceutical Distributor Danco’s $765,000 False Claims Act Settlement Shows Importance Of Customs Marking and Duty Rules
- $400K EEOC Settlement Warns Health Care Organizations Against Pregnancy Discrimination
- 2 Pharmacy FCA Convictions WarnAgainst Billing Or Undelivered Drugs Or Care
- “Rock Doc” Opioid Conviction Reaffirms DOJ Prioritization & Frequent Success of Illegal Opioid Distribution Enforcement
- Health Care Provider Pays $4 Million For Making Prohibited Donations Toward County Medicaid Funding
- OIG Asks Cigna MA Plans To Refund $6 Million, Clean Up Plan Processes After Poor Audit Results
- FY 2022 Medicaid Fraud Conviction Increase, Other Data Shows Continued Robustness of Federal Medicaid Enforcement
- Health Care Providers Should Verify Compliance, Audit Risks In Preparation For End of COVID Flexibilities
- Prepare To Handle Justice Department Marijuana Pardon Certificates From Applicant
- Sentencings & Charges Of Clinic Operators For Defrauding Health Plans Highlight Risks Of Involvement In Schemes To File Fraudulent Health Benefit Claims
- Former Missouri Lawmaker Sentenced On COVID & Stem Cell Fraud, Illegally Distributing Prescription Drugs & False Statements
- Ensure Health Care & Other Compliance Practices Updated For New DOJ Voluntary Disclosure Policy
- F-1 Visa Guidance Could Impact Health Industry Work Eligibility Of Some Foreign Students
- DOJ Withdraws Health Care Antitrust Policy & Enforcement Statements
IMPORTANT NOTICE ABOUT THIS COMMUNICATION
If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information including your preferred e-mail by creating your profile here.
NOTICE: These statements and materials are for general informational and educational purposes only. They do not establish an attorney-client relationship, are not legal advice or an offer or commitment to provide legal advice, and do not serve as a substitute for legal advice. Readers are urged to engage competent legal counsel for consultation and representation in light of the specific facts and circumstances presented in their unique circumstances at any particular time. No comment or statement in this publication is to be construed as legal advice or an admission. The author and Solutions Law Press, Inc.™ reserve the right to qualify or retract any of these statements at any time. Likewise, the content is not tailored to any particular situation and does not necessarily address all relevant issues. Because the law is rapidly evolving and rapidly evolving rules make it highly likely that subsequent developments could impact the currency and completeness of this discussion. The author and Solutions Law Press, Inc.™ disclaim, and have no responsibility to provide any update or otherwise notify anyone of any such change, limitation, or other condition that might affect the suitability of reliance upon these materials or information otherwise conveyed in connection with this program. Readers may not rely upon, are solely responsible for, and assume the risk and all liabilities resulting from their use of this publication. Readers acknowledge and agree to the conditions of this Notice as a condition of their access to this publication.
Circular 230 Compliance. The following disclaimer is included to ensure that we comply with U.S. Treasury Department Regulations. Any statements contained herein are not intended or written by the writer to be used, and nothing contained herein can be used by you or any other person, for the purpose of (1) avoiding penalties that may be imposed under federal tax law, or (2) promoting, marketing or recommending to another party any tax-related transaction or matter addressed herein.
©2023 Cynthia Marcotte Stamer. Limited non-exclusive right to republish granted to Solutions Law Press, Inc.™