CMS Fights Against COVID-19 Medicare Fraud

DOJ Charges

On Wednesday, May 26, the Centers for Medicare and Medicaid Services (CMS) announced it would take administrative action against more than 50 health care providers for COVID-19 related health care fraud and abuse of programs implemented by CMS during the pandemic.

That same day, the U.S. Department of Justice announced criminal charges against 14 defendants whose alleged participation in COVID-19 fraud schemes resulted in over $143 million worth of false billings.

Telehealth Expansion Abuse

Many of these charges relate to the telehealth expansion implemented by CMS in March 2020. During the pandemic, the expansion increased the types of virtual care services providers could be reimbursed for by Medicare and allowed for reimbursement of audio only telehealth appointments when video conferencing was not possible. 

According to the DOJ, several defendants submitted false claims and billed for telehealth services that were never provided.

Covid Testing Scams

Additionally, multiple defendants are accused of offering COVID-19 tests to Medicare beneficiaries at nursing homes, assisted living facilities, and other testing sites, with the goal of obtaining personal identifying information and blood and/or saliva samples, both of which are not necessary for the COVID test itself. Allegedly, these defendants then misused the information obtained to submit fraudulent Medicare claims for more expensive testing that was medically unnecessary or in some cases never provided.

Some defendants are alleged to have bribed medical professionals for testing referrals.

Why is medicare fraud a concern?

Health care fraud, particularly Medicare fraud is a serious issue. When this type of fraud is committed, Medicare funds that could have been allocated to real services provided to actual beneficiaries go directly to the pockets of fraudulent providers. 

The fact that some health care providers took advantage of programs meant to increase care for beneficiaries during a national pandemic, like Medicare’s telehealth expansion, can be especially demoralizing. FBI director Christopher Wray acknowledges this.

“It’s disheartening that some have abused their authorities and committed COVID-19 related fraud against trusting citizens,” Wray said in a DOJ press release. “The FBI, along with our federal law enforcement and private sector partners, are committed to continuing to combat healthcare fraud and protect the American people.”