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3 ways feds are cracking down on pandemic related healthcare fraud

by | Jun 3, 2021 | Health & Health Care Law, Health Care Investigations |

The feds are aggressively pursuing allegations of healthcare fraud related to relaxed regulations and incentives to help address the pandemic. In a recent example, the government charged 14 people with healthcare fraud related to the pandemic. They claim that those listed in the charges are responsible for $114 million in ill-gotten gains as a direct result of insurance claims from COVID related healthcare services. The charged include physicians and those who own labs, pharmacies and home health agencies located in New York, New Jersey, Florida, Louisiana, Arkansas, and California.

Example #1: Using COVID-testing to add additional medical care

According to the official announcement by the United States Department of Justice (DOJ), the fraud in this example took place when representatives would run COVID-19 testing sites. When they got samples to check for the virus, they would also run additional expensive and allegedly medically unnecessary tests. These tests included genetic screening for cancer and allergy tests. The government further states that the providers did not always share the results with the patients or their primary care physicians.

Those facing charges could counter these allegations relatively quickly. Unfortunately, the government claims to have more. They state they have proof that those involved took steps to hide the money that was paid through insurance claims related to these tests. These steps allegedly involved use of shell companies.

Example #2: Abuse of telehealth

This example outlined above is just one way the feds are cracking down on healthcare fraud related to the pandemic. They are also looking into situations where healthcare providers may have billed for telehealth appointments that did not happen or were not medically necessary.

Example #3: Misuse of Provider Relief Funds

The government also states some healthcare professionals misused funds provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act in the Provider Relief Fund. Use of these funds for anything other than COVID-19 related care efforts or supporting small businesses disrupted by the pandemic can lead to allegations of misappropriation.

It is important to take these types of allegations seriously. These accusations can come with more than just a fine and verbal reprimand. Depending on the details of the allegations, the accused can also face imprisonment and loss of their professional license.

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