DOJ charges 21 defendants with COVID-related healthcare fraud schemes totaling $149M

The Department of Justice (DOJ) uncorked a slew of new charges Wednesday against 21 defendants accused of various healthcare fraud schemes involving the COVID-19 pandemic.

The DOJ said the cases allegedly led to more than $149 million in false billings to federal programs and theft from federally funded assistance programs and cost over $8 million as part of its enforcement.

“This COVID-19 health care fraud enforcement action involves extraordinary efforts to prosecute some of the largest and most wide-ranging pandemic frauds detected to date,” the DOJ’s Director for COVID-19 Fraud Enforcement, Kevin Chambers, said in a statement. “The scale and complexity of the schemes prosecuted today illustrate the success of our unprecedented interagency effort to quickly investigate and prosecute those who abuse our critical health care programs.”

The cases are spread across nine federal districts and take several different forms, according to the DOJ.

Multiple newly announced cases were tied to COVID-19 testing services defendants allegedly used to collect patients’ personal identifying information and saliva or blood samples, which then were allegedly used to submit false and fraudulent Medicare claims, according to the announcement. One such scheme in California saw two clinical laboratory owners charged for over $214 million in fraudulent lab test billing, more than $125 million of which related to COVID-19 and respiratory pathogen tests, the DOJ said.

Another scheme cited by the department in Florida involved a medical professional allegedly billing for sham telemedicine encounters and agreements to order unnecessary genetic tests.

Three California defendants were hit with charges for a scheme to sell homeoprophylaxis immunizations against COVID-19 and falsify vaccine record cards. Two other defendants were charged for schemes targeting the Provider Relief Fund, bringing the total to 10 defendants charged to date for misappropriating the relief money.

Concurrent to the charges, the Centers for Medicare & Medicaid Services' (CMS') Center for Program Integrity announced 28 new administrative actions against providers for COVID-19 care fraud, waste and abuse schemes or other schemes involving the public health emergency.

“We are committed to working closely with our law enforcement partners to combat fraud, waste and abuse in our federal health care programs,” CMS Administrator Chiquita Brooks-LaSure said in a statement. “The administrative actions CMS has taken protect the Medicare Trust Funds while also safeguarding people enrolled in Medicare.”

It’s been nearly a year since the attorney general established the COVID-19 Fraud Enforcement Task Force, a partnership between the DOJ and other government agencies that investigates and prosecutes such cases.

To date, the DOJ said its Health Care Fraud Strike Force has charged over 4,200 defendants who collectively billed Medicare for nearly $19 billion. More than $5 billion of those recoveries came in 2021 alone.

“The [DOJ’s] Health Care Fraud Unit and our partners are dedicated to rooting out schemes that have exploited the pandemic,” Assistant Attorney General Kenneth A. Polite Jr. of the DOJ’s Criminal Division said in a statement. “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.”