Dive Brief:

• The Department of Justice has charged 21 people across the U.S. for pandemic-related healthcare fraud, federal prosecutors said Wednesday.
• Defendants — including doctors, medical business executives and fake vaccination card manufacturers — caused nearly $150 million in false billing to federal programs, the DOJ alleged.
• The prosecution effort involves some of the "largest and most wide-ranging pandemic-related frauds detected to date," said Kevin Chambers, the DOJ's director for COVID-19 fraud enforcement.

Dive Insight:

The DOJ has been stepping up enforcement action against fraud over the course of the pandemic. The rapid expansion of COVID-19 testing and vaccination, combined with billions in new federal dollars to combat the pandemic, resulted in a barrage of fraud in the healthcare industry, leading the DOJ to form a specific pandemic-related task force last May.

Last year, prosecutors charged another dozen healthcare providers with COVID-19-related fraud totaling $143 million in false billing.

The newly prosecuted healthcare fraud schemes "exploited the COVID-19 pandemic," Assistant Attorney General Kenneth Polite of the DOJ's criminal division said in a statement, and were run by people who "placed greed above care during an unprecedented public health emergency."

In several cases, defendants allegedly offered COVID-19 testing to get patients' personal identifying information and a saliva or blood sample, before using that data to submit false claims to Medicare for unrelated, medically unnecessary and expensive tests or services.

One such scheme in California involved two owners of a clinical laboratory who fraudulently billed for more than $214 million for lab tests — more than $125 million of which involved fake claims during the pandemic for COVID-19 and respiratory pathogen tests.

In two separate cases in Maryland and New York, medical clinic owners allegedly obtained confidential information from patients looking for drive-thru COVID-19 testing, then submitted fraudulent claims for office visits that didn't take place.

Another type of fraud involved telemedicine, which the CMS embraced in the early days of COVID-19, causing digitally delivered care to soar. According to the DOJ, in one instance a Florida physician billed for sham telemedicine visits that didn't occur and agreed to order unnecessary genetic testing in exchange for access to telehealth patients.

Late last year, one defendant was sentenced to almost seven years in prison for connection with the scheme.

The new allegations also includes charges against two additional defendants for schemes targeting the Provider Relief Fund, set aside in 2020 to bolster hospitals' flagging finances as inpatient volumes fell during COVID-19.

In total, 10 defendants have been charged with crimes related to misappropriating PRF dollars, while three have pled guilty, DOJ said.

Alongside the enforcement action, the CMS also announced it has taken an additional 28 administrative actions against providers for alleged fraud, waste and abuse related to COVID-19 care delivery or the public health emergency.