Earlier this month, the U.S. Department of Health and Human Services, Office of Inspector General (HHS, OIG) issued a special fraud alert advising healthcare providers to exercise caution when contracting with telemedicine companies. Such alerts are significant as they put providers on notice that OIG intends to investigate and prosecute potential fraud regarding telemedicine/. Such notices provide the opportunity for healthcare providers to review their practices and compliance, as well as list examples of suspect practices in the industry.

Historically, federal regulations limited the use and scope of telemedicine. It became widely available, however, during the COVID crisis that necessitated the loosening of government regulations. While a relaxation of regulations and restrictions offered patients greater access to physicians, it also opened the door to fraudulent conduct. In previous articles, we explored schemes involving compound medicines, genetic cancer screening (CGx and PGx tests) and durable medical equipment (DME) such as orthotic braces.

This latest fraud alert confirms that OIG is still aggressively targeting DME companies, laboratories and pharmacies using telehealth services. The OIG alert offers a non-comprehensive list of factors that they examine in potential fraud cases, including:

1. Patients that are referred to a practitioner through a telemedicine company, telemarketing, recruiter, call center, health fair or internet;
2. Practitioner has only limited access or contact with the alleged patient to meaningfully access the medical necessity of the services solicited;
3. Telemedicine company compensates the practitioner based on the volume of prescriptions and services;
4. Telemedicine company only provides services to federal health care program beneficiaries, and does not accept private insurance;
5. Telemedicine company only provides a single class of products such as braces, genetic testing, compound medicines – pain, scar and vitamin creams – thus limiting a practitioner’s treatment options; and
6. Telemedicine company does not expect its physicians to follow up with the patients regarding their prescriptions or services.

This alert expressly notes that proactive marketing that advertises free or low cost items or services covered by federal healthcare programs and exclusively marketed to such beneficiaries is “suspect”. Additionally, any program that limits a practitioner from contacting a patient to follow up or offer other medical services is suspect.

While HHS, OIG alerts provide valuable guidance for practitioners and other healthcare professionals, they also provide federal prosecutors the opportunity to argue that a provider’s good faith defense is limited after such an alert has been issued, i.e. that providers are on notice that such practices as suspect.

Stahl Gasiorowski Criminal Defense Attorneys have represented dozens of physicians, marketers, telehealth companies and pharmacists in federal healthcare fraud investigations. We proactively and aggressively protect our clients’ rights. To contact Mr. Stahl, call 908.301.9001 for the NJ office and 212.755.3300 for the NYC office, or email Mr. Stahl at rgs@sgdefenselaw.com.

The Department of Justice just announced charges against 21 individuals in a nationwide crackdown of COVID-19 related prosecutions that resulted in $150 million worth of fraud. The schemes were varied and involved medical doctors, medical labs, marketers and others in the healthcare field.

For instance, two owners of a lab in California allegedly billed more than $125 million in fraudulent claims. In Maryland and New York drive through test site operators are accused of using confidential patient information to bill for lengthy office visits that never occurred. In New Jersey, five individuals were accused of paying or receiving kickbacks for referring COVID tests to a particular lab. Even though the tests were medically necessary, and the lab only billed the allowable rate to the government program, the lab was accused of violating the anti-kickback statute that prohibits paying individuals or companies to refer tests.

The Maryland case charged a physician with submitting false claims to Medicare and private insurers. The defendant owned drive through COVID testing sites. Employees gathered patient information at the sites and later submitted false claims for complex in office visits for other healthcare procedures that never occurred.

In Florida, a registered nurse was charged with signing huge numbers of medically unnecessary doctor’s orders in exchange for sham telemedicine consulting fees. Another case in Florida charged individuals with fraudulent Medicare billing for medical equipment that was obtained by paying kickbacks to marketing companies that solicited patients for equipment they didn’t need.

In other schemes, defendants in California were charged with allegedly counterfeiting vaccine cards. Another case involved a hospital pharmacy director who obtained authentic Moderna dose lot numbers and used them to falsify vaccine ecards.

In New Jersey, one of the District’s first healthcare fraud trials just resulted in a guilty verdict against a medical sales representative of a diagnostic lab who paid kickbacks to a physician for referring tests to the lab. In an effort to disguise the kickbacks, the marketer placed the physician’s medical assistant on the lab’s payroll. In a related scheme, the marketer was paid for promoting medically unnecessary compound medicines that certain insurance plans covered. The defendant and others paid kickbacks to doctors to prescribe the unnecessary compounds without even examining the patients.

Other cases have charged individuals with fraudulently obtaining relief funds from the Coronavirus Aid, Relief and Economic Security Act. A 2020 bill that provided billion in emergency financial assistance.

These and scores of other cases highlight federal authorities continuing investigations and DOJ’s aggressive prosecution of a variety of healthcare fraud schemes. These schemes involve medically unnecessary compound medicines, genetic cancer tests, kickbacks on prescriptions for DME – durable medical equipment – such as braces, as well as COVID-19 tests.

Federal healthcare laws and regulations are complex. There are countless ways for doctors, pharmacists, lab owners and marketers to violate these laws. Stahl Gasiorowski Criminal Defense Lawyers have extensive experience representing individuals and corporations accused of healthcare fraud. To contact the firm’s NJ office, call 908.301.9001 and to contact the firm’s NYC office, call 212.755.3300, or email Mr. Stahl at rgs@sgdefenselaw.com.

In addition to the 93 U.S. Attorney’s Offices around the country that investigate and prosecute health care fraud, the Fraud Section of the Department of Justice’s Criminal Division based in Washington D.C. has approximately 76 federal prosecutors devoted to such prosecutions. This DOJ Unit targets complex health care fraud involving illegal prescription, distribution and diversion of opioids; telemedicine fraud; and fraud related to COVID, including counterfeit vaccine cards.

The just released year-end report for 2021 reveals the total cases prosecuted and significant cases of note. The unit charged 202 individuals involved in $1.75 billion in alleged losses, with a significant number of guilty pleas, as well as convictions at trial.

Just in September 2021 alone, DOJ announced charges against 138 defendants, including 42 medical professionals, in connection with a national health care fraud enforcement action.

The Unit is assisted by a data analytics team that identifies suspicious health care billing patterns and likely geographic hotspots for fraud and illegal opioid distribution. In 2021, this data analytics team made 385 proactive investigative referrals to various federal law enforcement agencies.

In addition to the illegal prescription and distribution of opioids, the Unit has aggressively targeted laboratories, telemedicine doctors and nurse practitioners, marketers and pharmacies engaging in illegal kickback schemes. These schemes are designed to induce medical professionals to order medically unnecessary compound medicines, such as pain creams, scar creams, vitamins and migraine medication; or orders for unnecessary laboratory tests for genetic cancer screenings. The payments include money based on a per prescription basis, whether in the form of direct payments, payments to the physician’s spouse, or disguised as lease payments or alleged ownership interest payments for a physician-owned lab.

Stahl Gasiorowski Criminal Defense Attorneys actively and aggressively defend clients being investigated and prosecuted for health care fraud. Over the past five years we have defended numerous physicians, pharmacists, marketers and lab owners accused of health care fraud. To contact Mr. Stahl, call 908.301.9001 for the NJ office and 212.755.3300 for the NYC office, or email Mr. Stahl at rgs@sgdefenselaw.com.

Each new administration, through its Attorney General, set policy as to the Department of Justice’s enforcement priorities. As the Assistant Attorney General in charge of the Criminal Division, Kenneth Polite recently outlined those priorities. In general, those areas include foreign corruption, computer crimes and money laundering/.

Polite announced that his office will be unveiling a new National Cryptocurrency Enforcement Team comprised of lawyers from the Division’s Computer Crime and Money Laundering Sections together with experienced AUSAs from around the country. This new initiative reflects the ongoing concern over the lack of regulations and enforcement of cryptocurrency and its use by cyber criminals, drug cartels and other money launderers around the world.

Continued emphasis will be placed on efforts to combat cyber-attacks and ransom demands from organized groups and state backed hackers from China, Russia and other countries. These ransomware attackers often demand payment in cryptocurrency as it is less traceable than traditional currency.

Other areas of enforcement will include healthcare fraud, opioid distribution, corporate compliance, and human trafficking. DOJ will bring together prosecutors from around the country, as well as agents from various federal law enforcement agencies and other partner agencies like the Commodities Trading Commission, SEC and FINCEN.

An adjunct to DOJ’s increased money laundering enforcement efforts is the Financial Crimes Enforcement Network (FINCEN) recent rule-making notice that it intends to draft “nationwide record keeping and reporting requirements” for certain participants in the non-financed real estate transactions that are made without mortgages or other lender provided credit. The purpose is to uncover money laundering activities in the approximately $460 billion annual cash real estate purchases in the United States. Presently, only banks and mortgage lenders have programs in place to report suspicious activities. FINCEN is considering how feasible it would be to add reporting requirements for title insurers, escrow companies, real estate attorneys and closing agents.

We have represented many doctors, pharmacists and marketing companies charged with healthcare fraud, and money laundering in federal court, as well as cryptocurrency and unregistered money transfer businesses. Stahl Gasiorowski Criminal Defense is here for all your criminal legal needs. We are experienced in all types of complex criminal matters involving many types of electronic evidence. To contact the firm’s NJ office, call 908.301.9001 and to contact the firm’s NYC office, call 212.755.3300, or email Mr. Stahl at rgs@sgdefenselaw.com.