Telemedicine is at the center of an illegal opioid ring, according to the DOJ.
The U.S. Department of Justice (DOJ) recently announced a nationwide opioid crackdown involving 345 defendants across 51 federal districts, including more than 100 doctors, nurses and other licensed medical professionals, all charged with healthcare fraud and opioid abuse. Investigators charged the defendants with “submitting more than $6 billion in false and fraudulent claims to federal healthcare programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million linked to substance abuse treatment facilities or sober homes,” and more than “$806 million related to other healthcare fraud and illegal opioid distribution schemes” across the U.S, according to the DOJ.
“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,” said Acting Assistant Attorney General Brian C. Rabbitt. “These cases hold accountable for those medical professionals and others who have exploited healthcare benefit programs and patients for personal gain. The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency.”
“A total of 16 defendants were charged for their alleged roles in schemes to defraud insurance programs out of $50 million,” according to court documents tied to the opioid crackdown. “Forty-six defendants were charged for their alleged roles in schemes to defraud insurance programs out of more than $58 million and opioid diversion related criminal conduct.” And “prosecutors charged eight defendants for their alleged involvement in multiple schemes, officials said. In one case, four people allegedly conspired to pay and receive kickbacks in exchange for fraudulent claims to federal health care programs. Within about eight months, the group obtained more than $2.9 million through the alleged scheme.”
Investigators said the largest amount of alleged health care fraud involved telemedicine, which has become especially popular amid the coronavirus pandemic as more and more individuals are opting to receive online care. The opioid crackdown showed clinicians have been dishing out additive painkillers without proper patient evaluations. The CMS Center for Program Integrity also recently announced the agency has taken “a record-breaking number of administrative actions related to telemedicine fraud, revoking the Medicare billing privileges of 256 additional medical professionals for their involvement in telemedicine schemes.”
“Telemedicine can foster efficient, high-quality care when practiced appropriately and lawfully. Unfortunately, bad actors attempt to abuse telemedicine services and leverage aggressive marketing techniques to mislead beneficiaries about their health care needs and bill the government for illegitimate services,” said Health and Human Services Deputy Inspector General Gary Cantrell. “Unfortunately, audacious schemes such as these are prevalent and often harmful. Therefore, collaboration is critical in our fight against health care fraud. We will continue working with our law enforcement partners to hold accountable those who steal from federal health programs and protect the millions of beneficiaries who rely on them.”
According to court documents, some telemedicine administrators allegedly paid physicians and nurse practitioners to order medical equipment, lab testing and pain medication, sometimes without any patient interaction. Those who executed the orders – including pharmacies, laboratories and equipment supply companies – in turn, received illegal kickbacks.