The Justice Department has charged 36 telehealth providers and executives across the country, as well as medical device companies, for participating in a Fraudulent scheme involving ordering unnecessary genetic testing in exchange for illegal kickbacks.
The charges relate to the country’s first cases involving fraudulent cardiovascular genetic testing, an “emerging program,” according to a DOJ press release.
As part of the program, telemedicine physicians will order cardiovascular tests after a very brief online visit with a patient, and the telemedicine company will then sell the prescription to a medical device company or clinical lab, which will bill Medicare. The medical device company or lab will then pay the telemedicine company a rebate.
“Cardiovascular genetic testing is not a method of diagnosing whether an individual currently has heart disease, nor is it approved by Medicare as a general screening test to indicate an increased risk of cardiovascular disease in the future,” according to a DOJ press release.
In one case, the operators of several labs were accused of paying more than $16 million in rebates to marketers, who then paid telehealth companies and call centers in exchange for orders from doctors. Laboratory operators filed more than $174 million in false and fraudulent Medicare claims, and the results of genetic testing were never used to treat patients.
The government has now seized $7 million in cash, several luxury cars, a yacht and property from the lab operator, which laundered the money through several bank accounts and entities.
“The Department of Justice is committed to prosecuting those who abuse our health care system and use telehealth technology in fraud and bribery schemes,” said Assistant Attorney General Kenneth A. Polite, Jr., of the Justice Department’s Criminal Division. “This enforcement action demonstrates that the department will do everything in its power to protect the health care system our communities depend on and prevent people from cheating them for their own selfish interests.”
In other cases, several individuals involved in telemarketing networks in the U.S. and overseas lure thousands of elderly and/or disabled patients to use their services. As part of the scheme, telemarketers manipulated Medicare beneficiaries into agreeing to cardiovascular genetic testing. Medical professionals are ordering genetic testing whether patients need it or not.
“Often, these test results or durable medical devices are not provided to patients or are of little value to their primary care physicians,” according to a DOJ press release.
As part of the investigation, the Centers for Medicare and Medicaid Services took action in similar cases. On Wednesday, CMS announced that the department had seized more than $8 million in cash, luxury cars and other fraudulent proceeds from 52 providers participating in similar schemes.
The investigation is just the latest in a string of telehealth fraud schemes. September, the U.S. Department of Justice announced The agency has sued more than 100 doctors and nurses in scams involving telehealth and illegal kickbacks, resulting in more than $1.4 billion in damages.
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