DOJ Brings Charges Against Defendants Alleging COVID-19 Related Fraud Schemes
By: Emily H. Lineweaver
On April 20, 2022, the Department of Justice (DOJ) announced it had brought criminal charges against 21 defendants in nine different federal district courts alleging participation in various health care related fraud schemes that exploited the COVID-19 pandemic.
Some defendants are accused of offering COVID-19 tests to their patients in order to obtain the patient’s personal identifying information, along with the patient’s saliva or blood sample, which were then used to submit false and fraudulent claims to Medicare, claiming far more expensive tests or services that were unrelated and medically unnecessary. “In one such scheme in the Central District of California, two owners of a clinical laboratory were charged with a health care fraud kickback and money laundering scheme that involved fraudulent billing of over $214 million for laboratory tests, over $125 million of which allegedly involved fraudulent claims during the pandemic for COVID-19 and respiratory pathogen tests.”
In a separate scheme, owners of a medical clinic allegedly submitted fraudulent claims for lengthy office visits with patients that did not occur. The patients went to the clinic seeking drive-thru COVID-19 testing. The owners were then able to obtain the patients’ confidential information, information that was used to submit the fraudulent office visit claims.
Other cases involve defendants allegedly billing for sham telemedicine encounters that did not occur, a scheme that took advantage of the loosened policies the Centers for Medicare and Medicaid Services (CMS) put in place during the pandemic to increase access to care, while others involve defendants allegedly misappropriating Provider Relief Funds intended for frontline medical providers. Another type of scheme involves manufacturers and distributors of fake COVID-19 vaccination record cards. “One defendant allegedly misused her position as the Director of Pharmacy at a northern California hospital to obtain real lot numbers for the Moderna vaccine that were then used to falsify vaccination records.” Assistant Attorney General Kenneth A. Polite, Jr. said, “The Department of Justice’s Health Care Fraud Unit and our partners are dedicated to rooting out schemes that have exploited the pandemic. Today’s enforcement action reinforces our commitment to using all available tools to hold accountable medical professionals, corporate executives, and others who have placed greed above care during an unprecedented public health emergency.”