Telemedicine Fraud — Notable Cases and the Role of the Whistleblower
Not only has the use of telemedicine risen to unprecedented levels during the Covid-19 pandemic, but the Centers for Medicare and Medicaid Services (CMS) decided to relax Medicare coverage rules regarding telemedicine last year. As a result, telemedicine represents a relatively uncharted frontier in the health care industry, offering hopes of increased access and care but also fears of exploitation and fraud.
Accordingly, the Department of Justice (DOJ) has set it as a core mission to aggressively pursue allegations of Medicare fraud in telemedicine. Below are a few cases that we at Price Armstrong believe are indicative of the DOJ’s commitment to eliminating telemedicine.
Notable Recent Cases Involving Telemedicine Fraud
In the fall of 2020, the DOJ charged 345 defendants with submitting false and fraudulent claims to federal health care programs and private insurers in its largest health care enforcement action ever. The DOJ reported that the defendants received more than $6 billion in false and fraudulent claims, with more than $4.5 billion of this amount coming from telemedicine.
In May 2021, the DOJ announced criminal charges against 14 defendants, alleging losses of over $143 million due to false billings. According to a press release, the defendants took advantage of the expanded Medicare regulations regarding telemedicine “by submitting false and fraudulent claims to Medicare for sham telemedicine encounters that did not occur.”
In August 2021, the owner of multiple telemedicine companies in Florida was charged with “orchestrating a health care fraud and illegal kickback scheme that involved the submission of over $784 million in false and fraudulent claims to Medicare.” The telemedicine Medicare fraud scheme is one of the largest ever charged by the Justice Department, according to a press release.
This past month, in September 2021, the DOJ instituted yet another health care enforcement action, this time against 138 defendants. The DOJ alleged that defendants improperly received over $1.1 billion through the submission of false and fraudulent claims involving telemedicine. According to court documents, the defendants’ fraud included, among other things, unnecessary services prescribed after little to no patient interaction, illegal kickbacks, and sham telehealth consultations.
The Whistleblower’s Role in Fighting Telemedicine Fraud
As the above cases make clear, the DOJ has its hands full in the fight against growing telemedicine fraud. This means that there is an important role for whistleblowers, acting pursuant to the False Claims Act (FCA), to play in eliminating this dangerous new area of fraud.
Under the FCA, private citizens can sue on behalf of the government for false claims made to the government. In doing so, the whistleblower receives both protection from retaliation and a handsome financial reward – usually between 15% and 30% of the total sum recovered.
Telemedicine fraud is not going anywhere anytime soon, so the DOJ needs whistleblowers acting under the FCA to held put an end to this growing area of abuse.
At Price Armstrong, we have extensive experience litigating health care fraud cases under the False Claims Act. We work hard to both protect whistleblowers and maximize their recovery under the False Claims Act. Contact us today for a free initial consultation and review of your case.