The health care workers involved provide vital telemedicine services, opioid treatment, prescription drug services, and durable medical equipment. The government claims the defendants submitted more than $6 billion of false claims to Medicare, Medicaid, and other insurance companies for these services. In addition to criminal charges, over 250 medical professionals had their Medicare and Medicaid billing privileges revoked and could be at risk of losing their medical licenses.
The government used a National Rapid Response Strike Force to coordinate its investigative efforts across 51 federal districts, including districts in Georgia. They focused on three initiatives including: 1) $4.5 billion in telemedicine fraud, 2) $845 million in “Sober Home” fraud, and 3) $806 million in illegal prescription or distribution of opioids. In general, the government alleges that doctors and other professionals were paid to see patients remotely via telemedicine and order services like pain medications, genetic lab testing, or durable medical equipment that the patients may not have needed. They also allege payment of illegal kickbacks for referrals to certain substance use treatment facilities. Some defendants were accused of submitting false or fraudulent claims for prescription drugs that were medical unnecessary or never provided.
Cases like these are becoming very common in light of the worldwide COVID-19 pandemic and national opioid addiction crisis. While the charges make sensational headlines, the government must prove beyond a reasonable doubt that the doctors and others involved knew what they were doing was illegal and that they received payments that were not proper.
Under the CARES Act, the government has loosened many telemedicine regulations due to COVID-19 that must be explored as part of a defense strategy. In addition, experts must review the government’s evidence including patient records, claims, medical coding, and other evidence to determine if the services were legitimate and medical necessary under the circumstances. Under a good faith defense, doctors are protected if they had a reasonable belief they were acting appropriately.
Health care fraud laws are numerous, complex, and can result in severe penalties. Our federal criminal defense attorneys have successfully represented dozens of doctors, healthcare professionals and executives against federal health care fraud charges. Contact us immediately if you think you may be targeted or have been indicted. We have the experience, resources, and knowledge to help you fight health care fraud charges.