Medicare and Health Test Fraud Tops U.S. Justice Department Agenda

Health fraud has landed on the U.S Justice Department’s radar of late, and a $1.2 billion crackdown has led to criminal charges against just under 40 defendants for operating with intentionally misleading billings. These charges are linked with tests and equipment for telemedicine as well as genetic and cardiovascular evaluation, and the individuals charged include telemedicine executives, medical professionals, marketers, and laboratory owners. The schemes collectively aimed to cheat some $1.2 billion from Medicare, though less than half of that came to fruition before the machinations were uncovered.

“The cases announced today include charges against people who brazenly used Medicare funds to purchase luxury items, medical professionals who corruptly approved testing and equipment, and business owners who submitted false and fraudulent claims for services patients did not need,” said Kenneth Polite, the head of the U.S. Justice Department's criminal division. In addition to a host of older and well-trodden kick-back and billing practices scamming Medicare, a newer tactic saw the schemers exploit patients’ fear of cardiovascular disease by encouraging medically unnecessary cardiovascular disease screening tests. Pricing for those tests has skyrocketed in the past year, with some of them being billed for up to $10,000 a piece. Associated claims can often pay out at nearly $8,000.

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The Center for Medicare Services, which is a division of the U.S. Department of Health and Human Services, is separately pursuing administrative action against more than 50 companies employing similar criminal schemes.