The U.S. Justice Department filed criminal charges against 36 people across the country for their alleged involvement in a more than $1.2 billion health care fraud.
Federal officials said on July 20 that the investigation involved alleged fraudulent telemedicine, cardiovascular and cancer genetic testing, and durable medical equipment schemes.
Seeking $7 million and a Tesla
The indictment seeks forfeiture of over $7 million, three properties, a yacht, a Tesla and other vehicles.
The investigations primarily targeted schemes involving payment of illegal kickbacks and bribes by laboratory owners and operators in exchange for patient referrals by medical professionals working with fraudulent telemedicine and digital medical technology companies.
Telemedicine schemes account for more than $1 billion of the total alleged intended losses, officials said.
The charges include some of the first prosecutions in the nation related to fraudulent cardiovascular genetic testing, a burgeoning scheme.
Medical professionals made referrals for expensive and medically unnecessary cardiovascular and cancer genetic tests, as well as durable medical equipment, the government said.
Over $16 Million in Kickbacks
"Cardiovascular genetic testing was not a method of diagnosing whether an individual presently had a cardiac condition and was not approved by Medicare for use as a general screening test for indicating an increased risk of developing cardiovascular conditions in the future," the Justice Department said in a statement.
One case involved the operator of several clinical laboratories, who was charged in connection with a scheme to pay over $16 million in kickbacks to marketers who paid kickbacks to telemedicine companies and call centers in exchange for doctors’ orders.
Orders for cardiovascular and cancer genetic testing were used by the defendant and others to submit over $174 million in false and fraudulent claims to Medicare—but the results of the testing were not used in treatment of patients.
The defendant allegedly laundered the proceeds of the fraudulent scheme through a complex network of bank accounts and entities, including to purchase luxury vehicles, a yacht, and real estate.
Worthless Testing
Some defendants charged allegedly controlled a telemarketing network, based both domestically and overseas, that lured thousands of elderly and disabled patients into a criminal scheme.
Telemedicine companies allegedly arranged for medical professionals to order these expensive genetic tests and durable medical equipment regardless of whether the patients needed them, and that they were ordered without any patient interaction or with only a brief phone conversation.
Often, officials said, these test results or durable medical equipment were not provided to the patients or were worthless to their primary care doctors.
Separately, the Centers for Medicare & Medicaid Services, Center for Program Integrity took administrative actions against 52 providers involved in similar schemes.
