The highest fraud schemes of Q2 2024

As we transfer by way of 2024, fraud, waste, and abuse (FWA) proceed to be signal­­­­ificant points inside healthcare. Perpetrators of fraud usually use ways resembling kickbacks, fraudulent claims, and exploiting susceptible populations to deceive Health plans, usually benefiting from susceptible sufferers within the course of. Right here’s a rundown of notable FWA instances from April to June 2024.

Nationwide healthcare fraud bust: $2.75 billion

193 individuals have been charged in a Health-care-fraud-garland-24948b951896d0f265c29ba3fcacf858″ rel=”noopener” goal=”_blank”>nationwide crackdown on healthcare fraud schemes involving false claims exceeding $2.7 billion, based on the Justice Division. The costs contain a number of medical professionals and schemes throughout the U.S., together with a big $900 million fraud scheme in Arizona concentrating on terminally in poor health sufferers. The Arizona case concerned two homeowners of wound care corporations who allegedly accepted kickbacks for fraudulently billing Medicare for pointless amniotic wound grafts, pressuring nurse practitioners to use these grafts to aged and hospice sufferers—a few of whom died shortly after receiving them.

Pharmacy Medi-Cal fraud scheme: $300 million

A California pharmacist has been charged with submitting over $300 million in fraudulent claims for unnecessary prescription medications to Medi-Cal, the state’s Medicaid program. The drugs had been usually not supplied to sufferers and had been obtained by way of unlawful kickbacks. The pharmacist faces two counts of healthcare fraud. From Could 2022 to March 2023, the pharmacist supposedly exploited Medi-Cal’s short-term suspension of prior authorization necessities by billing tens of hundreds of thousands per 30 days for high-reimbursement generic medicine.

Telemarketer fraud: $174 million

A Missouri man and a person from New Orleans have been Health-care-fraud” rel=”noopener” goal=”_blank”>indicted on conspiracy to commit healthcare fraud and different prices. Prosecutors allege that from November 2018 to July 2020, they ran a number of labs that paid kickbacks to telemarketers for Medicare beneficiary Information. The telemarketers purportedly then satisfied beneficiaries to conform to genetic testing by way of aggressive campaigns.

Bodily remedy fraud: $80 million

Three individuals had been arrested for Health-care-fraud-scheme/” rel=”noopener” goal=”_blank”>trying to defraud a healthcare profit program involving bodily remedy, based on federal paperwork. These co-conspirators operated a number of clinics underneath a wellness heart title and allegedly defrauded a federal employee’s compensation program. A kind of arrested is accused of submitting round $80 million in false claims to a federal company, together with exaggerated claims for bodily remedy companies.

Sturdy medical gear fraud: $70 million

A Mississippi man has been charged in reference to a $70 million durable medical equipment (DME) fraud scheme. He allegedly managed a number of DME corporations with out disclosing his involvement to Medicare. He and his co-conspirators are accused of utilizing these corporations to invoice Medicare fraudulently for orthotic braces that weren’t medically mandatory, not supplied as billed, or ineligible for reimbursement, utilizing medical doctors’ orders obtained by way of kickbacks and bribes.

COVID-19 testing fraud: $36 million

Three individuals have been indicted for his or her alleged involvement in a healthcare fraud, wire fraud, and cash laundering scheme associated to false COVID-19 claims. They allegedly submitted fraudulent claims to healthcare applications, together with Medicare and the Health Assets and Providers Administration (HRSA) COVID-19 Uninsured Program. The scheme is believed to have included paying unlawful kickbacks to affected person recruiters for take a look at referrals and billing for unauthorized assessments.

Genomic testing fraud: $25 million

A person from Florida is dealing with potential imprisonment for his alleged involvement in submitting fraudulent Medicare claims. The costs he faces are associated to claims made between late 2018 and 2019 involving a supposed scheme for most cancers genomic testing. The person and his co-conspirators allegedly acquired 1000’s of take a look at samples from Medicare beneficiaries by way of focused campaigns and despatched them to a medical heart that lacked correct gear for testing. In response to the courtroom, the samples had been then despatched to a third-party lab the place telemedicine medical doctors who weren’t certified to interpret the outcomes supplied prescriptions to justify reimbursement.

Fraudulent hospice Medicare claims: $15 million

Federal officers have arrested 5 individuals in Los Angeles for allegedly defrauding Medicare through fraudulent hospice services. Three of these arrested had been believed to be working faux hospice corporations, submitting claims for sufferers who weren’t terminally in poor health and had not acquired the purported care. They allegedly used medical doctors’ identities with out authorization to validate the false claims, and used the identities of Russian and Ukrainian residents to open financial institution accounts and leases, falsely presenting them because the hospice firm homeowners.

Genetic testing fraud: $12 million

A nurse from New Orleans was indicted on Health-care-fraud/article_8a79149e-041d-11ef-935f-b78d9017dc42.html” rel=”noopener” goal=”_blank”>six counts of healthcare fraud associated to alleged fraudulent Medicare claims. The indictment states that for a 12 months, she accepted bribes from a Utah firm to submit claims for most cancers genetic testing, which Medicare doesn’t sometimes cowl until ordered by a doctor. The assessments had been marketed as low-cost to contributors, and the nurse allegedly had minimal interplay with them earlier than submitting the claims. The indictment claims these orders had been induced by kickbacks and weren’t medically mandatory.

Non-covered companies fraud: $1.9 million

Two co-owners of a holistic healthcare heart have been charged with Health-care-centers-charged-Health-care-fraud” rel=”noopener” goal=”_blank”>defrauding federal and personal healthcare insurance coverage suppliers. The 2 allegedly submitted fraudulent claims for remedies not supplied or not lined. The middle, with workplaces in varied places, allegedly billed for non-covered companies like massages, used incorrect billing codes to keep away from denials, and claimed excessive complexity workplace visits with out offering such companies.