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14 Health Care Professionals Ensnared In DOJ COVID-19 Fraud Enforcement

14 Health Care Professionals Ensnared In DOJ COVID-19 Fraud Enforcement

Source : Medtech Insight

A COVID-19 fraud task force recently announced by the US Department of Justice (DOJ) has already charged more than a dozen people in a multi-state enforcement crackdown involving more than $143m in false claims for coronavirus diagnostics.

Of the defendants, 11 are newly charged while the other three are facing additional allegations under superseding indictments. The cases are being brought in seven federal districts in six states, including Arkansas, California, Florida, Louisiana, New Jersey and New York.

While the details of each case differ, many share some broad similarities. Most of the defendants reportedly offered COVID-19 tests to Medicare beneficiaries at senior living facilities, drive-through testing sites and medical offices. Once the blood or saliva sample and Medicare beneficiary information were obtained, they then submitted claims to Medicare for additional testing that was unnecessary and much more expensive, such as cancer genetic testing, allergy testing and respiratory panel pathogen tests. In some cases, the COVID-19 test results were unreliable or weren’t delivered to beneficiaries in a timely manner, further risking public health.

“It’s clear fraudsters see the COVID-19 pandemic as a money-making opportunity – creating fraudulent schemes to victimize beneficiaries and steal from federal health care programs.” – Gary Cantrell

The DOJ says the fraudulently obtained payments were often then laundered through shell companies and used to buy exotic automobiles and luxury real estate.

“It’s clear fraudsters see the COVID-19 pandemic as a money-making opportunity – creating fraudulent schemes to victimize beneficiaries and steal from federal health care programs,” Gary Cantrell, deputy inspector general for investigations in the Department of Health and Human Services Office of the Inspector General, said in a statement. “Our agency and its law enforcement partners are aggressively and effectively investigating these egregious crimes, which is made equally clear given the results of this takedown. We will continue to support the unprecedented COVID-19 public health effort by holding accountable people who use deceptive tactics to profit from the pandemic.”

The largest single case brought as part of the enforcement action is that of Billy Joe Taylor of Lavaca, AR, who is facing health care fraud charges worth more than $88m, of which $42m involves fraudulent claims directly tied to the pandemic. As owner and operator of Vitas Laboratories LLC and Beach Tox LLC, Taylor allegedly used access to beneficiary and medical provider information from previous legitimate testing to submit fraudulent claims for urine drug tests, respiratory pathogen panels, COVID-19 tests and other diagnostics that weren’t actually ordered or performed. Hundreds of claims were submitted for beneficiaries who had died or were no longer providing samples, the DOJ says.

Another case in the sweep is that of Mark Schena, president of medtech firm Arrayit Corp. Schena and two co-conspirators are facing charges related to the submission of more than $70m in false and fraudulent claims for allergy and COVID-19 testing. Schena and the others reportedly induced physicians to order Arrayit’s unreliable COVID-19 test, as well as the company’s medically unnecessary allergy test. A new superseding indictment includes additional charges of health care fraud, conspiracy to pay kickbacks, and payment of kickbacks.("Attorneys Expect COVID19 Enforcement Press Centered On PREP Act Diagnostics" "Medtech Insight" )

Meanwhile, two Palm Beach, FL, men face charges of conspiracy to defraud the US kickback allegations over a scheme to exploit Medicare’s loosened restrictions on telehealth during the pandemic. Consulting firm owner Michael Stein and testing lab owner/operator Leonel Palatnik reportedly worked together to offer telehealth providers access to Medicare beneficiaries – and the resulting consultation fees — in exchange for referring the clients to Palatnik’s labs for expensive and medically unnecessary cancer and cardiovascular genetic testing.

Others charged during the enforcement press include a Los Angeles home health company owner, two Florida patient brokers who recruited beneficiaries for unnecessary testing, a Louisiana clinical laboratory owner, a physician based in Queens, NY, and a partner in a Staten Island, NY, diagnostic lab.

The COVID-19 fraud task force held its first official meeting on 27 May under the guidance of deputy attorney general Lisa Monaco, at which members discussed priorities such as increased efforts to combat fraud related to COVID-19 relief programs like the Paycheck Protection Program, the Economic Injury Disaster Loan program and unemployment benefits, as well as health care fraud. The task force partners with the DOJ with other enforcement agencies across the federal government.

By Elizabeth Orr