Record year for investigators in healthcare fraud cases

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U.S. authorities are said to have opened a record number of healthcare fraud-related cases in 2020, as unscrupulous individuals attempt to profit during the pandemic.

Michael Granston, deputy assistant attorney general in the civil division of the Department of Justice, revealed the news at the American Health Law Association’s annual meeting this week, according to Bloomberg Law.

The DoJ opened a total of 900 new cases last year, 580 of which were linked to healthcare fraud, according to the report.

The numbers show the scale of the challenge facing private insurers and the US government’s national health insurance program Medicare.

Fraudulent schemes can take many forms, including fake accidents, billing for services not rendered, unnecessary prescriptions and / or medical devices, and the fraudulent use of stolen patient and physician identities.

Programs sometimes involve multiple parties, including unscrupulous doctors and clinics. The growth of telemedicine during the pandemic appears to have led to a new wave of fraud, as it is easier to tamper with consultations and prescriptions when patients do not physically come to clinics.

In April 2021, a Florida man was sentenced to a decade behind bars for his role in a $ 3.3 million conspiracy to defraud Medicare by filing claims for expensive genetic cancer tests including patients did not need.

This program involved the participation of telemedicine companies and unscrupulous testing laboratories. The former received bribes from the culprit to get doctors to allow unnecessary testing, while the latter paid him bribes for extra business in their labs.

A separate fraud conspiracy was revealed last year involving former NFL players who submitted millions of claims for expensive medical equipment, including hyperbaric oxygen chambers, which were never purchased or received. .

The DoJ claimed earlier this year that it recovered more than $ 2.2 billion in False Claims Act settlements and judgments in fiscal 2020.

Investigators now focus on those who abuse electronic health records, unduly claim COVID-19 relief funds, target Medicare’s managed care program, defraud the elderly, and contribute to the opioid epidemic, Granston says .

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