Over the past 10 years the Department of Justice and U.S. Attorneys’ Offices around the country have focused their investigative efforts on the billions of dollars that have been fraudulently billed to federal and private health insurers. Medicare, Tricare, Medicaid and private insurance companies have been the victims of numerous fraudulent schemes, most notably medically unnecessary prescriptions and testing for compound medicines, durable medical equipment, genetic cancer screening and blood testing. These various schemes often involve corrupt physicians, lab owners, pharmacists, marketers and patients paid to receive these tests and prescriptions.

While DOJ has been widely successful in investigating and prosecuting these schemes, with billions of dollars ordered in forfeiture and restitution payments, as well as lengthy prison sentences, seemingly as one type of health care fraud scheme has run its course, others come to light. DOJ has even formed task forces in several areas of the country that partner with the local U.S. Attorney’s Office and FBI, IRS, HHS-OIG agents to investigate.

Recognizing the continuing seriousness of health care fraud, just this week DOJ announced that it will focus its health care fraud investigations on Medicare Part C and COVID-19 testing scams. Investigations will be ramped up into providers that submit fraudulent paperwork to increase their reimbursement from Medicare Part C plans, known as Medicare Advantage. Since half of all Medicare beneficiaries participate in Medicare Advantage plans, it is a large pool of beneficiaries to target for fraud.

In addition, DOJ continues to target pandemic-related schemes such as providers that ordered COVID-19 testing for groups of patients along with unrelated and unnecessary tests such as genetic cancer screening CGx tests. A number of these schemes involved COVID-19 testing at health fairs and senior citizen facilities that also provided “free” genetic cancer screening based on family history. The Medicare or privately insured patients had no idea that there providers would be billed thousands of dollars for these tests with little or no follow up by a physician or genetic counselor.

Federal healthcare laws and regulations are complex. There are countless ways for physicians, pharmacists, lab owners and marketers to violate these laws. Stahl Criminal Defense Lawyers have extensive experience representing individuals and corporations accused of healthcare fraud. We have represented dozens of physicians, lab owners, pharmacists, marketers and DME companies in federal courts. 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 rstahl@stahlesq.com.