The highest healthcare fraud schemes of Q3 2023

As we evaluation the third quarter of 2023, we’re confronted with a resurgence of fraud, waste, and abuse (FWA) circumstances that proceed to focus on each private and non-private payers. These circumstances persistently make use of a variety of misleading ways, together with kickbacks, falsified claims, and the exploitation of susceptible people. With assist from the Nationwide Health Care Anti-Fraud Affiliation (NHCAA), we have diligently compiled a complete listing of great FWA circumstances that emerged between July and September 2023.

Fraud, kickbacks, and cash laundering: $170 million

Two pharmacists and a doctor have been charged with taking part in a multimillion-dollar healthcare fraud, kickback, and money laundering plot concentrating on the federal staff’ compensation program. The group allegedly referred medically pointless, costly prescriptions to one another in change for unlawful kickbacks and bribes. The indictment additional alleges that one of many defendants conspired to launder the illicit positive aspects from these actions by way of giant monetary transactions exceeding $10,000.  

Genetics testing fraud: $142 million

Three Texans have been charged for his or her alleged function in falsifying testing records to inflate reimbursement from Medicare. Allegedly, the 2 manipulated the dates of service on testing orders, creating the impression that they’d gathered quite a few DNA samples on varied events. This allowed them to cost for a number of service dates, consequently inflating their reimbursement for genetic testing claims. Officers additionally consider the 2 paid unlawful kickbacks to entrepreneurs and medical doctors for testing recipient Information.

Two individuals who operated a sequence of bodily remedy clinics have been charged with a number of counts of healthcare fraud, healthcare fraud conspiracy, and money laundering. The 2 are stated to have participated in false, inflated claims for remedy, fictional medical visits, extreme remedy, and fraudulent sturdy medical tools for bodily remedy companies price over $80 million to the Division of Labor for federal staff. A kind of charged additionally allegedly claimed to be a doctor as an alternative of a doctor’s assistant.

Pharmaceutical fraud: $33 million

A pharmacist and two executives are accused of Health-care-fraud-wire-fraud-and” rel=”noopener” goal=”_blank”>Medicare and TRICARE fraud. In line with courtroom paperwork, the 2 allegedly used telemedicine to work with advertising and marketing corporations to fill pointless prescriptions for costly medicines and fraudulently submitted reimbursements to Medicare and TRICARE. The advertising and marketing corporations supposedly pressured beneficiaries by telephone to comply with strive the costly medicines, together with varied lotions and migraine treatment. 

Fraud, kickbacks, and cash laundering: $20 million

Two acupuncturists, two bodily therapists, and an insurance coverage firm worker have been charged with Health-care” rel=”noopener” goal=”_blank”>a number of healthcare violations involving kickbacks. In line with courtroom paperwork, the defendants claimed to carry out bodily remedy and acupuncture companies that have been allegedly not offered as described or weren’t offered in any respect. The group additionally is claimed to have offered money kickbacks to sufferers for sharing insurance coverage Information and receiving pointless or non-existent companies.

Fraudulent Medicare tools claims: $14 million

Two operators of a sturdy medical tools agency have been charged for a Medicare scheme totaling $14 million. Since 2019, the 2 allegedly submitted fraudulent claims to Medicare to buy and restore energy wheelchairs, energy scooters, and different tools, together with billing greater than $700,000 in components and repairs for a single affected person.

Dental care fraud: $10 million

State attorneys filed a lawsuit towards a dental administration firm for healthcare fraud. The lawsuit claims that the corporate submitted claims to Medicare and personal insurance coverage on behalf of their sufferers with out their permission and didn’t inform sufferers of their rights and protections. The defendants additionally allegedly didn’t inform sufferers that the companies wouldn’t be coated beneath insurance coverage, or they claimed the associated fee was increased than the true price, all whereas charging charges for third-party loans.

Specialty drug fraud: $7 million

Three healthcare suppliers have been charged for an alleged scheme that Health-care-fraud-scheme” rel=”noopener” goal=”_blank”>defrauded Medicare and Blue Care Community. For a number of years, a licensed pharmacist supposedly labored with a pharmacy technician and a doctor on writing prescriptions for medically pointless specialty medication, which they resold to home and overseas companies at 100% revenue.

Faux HIV treatment payments: $3 million

The proprietor and supervisor of a pharmacy have been charged with a number of violations for a Medicare scam totaling nearly $3 million. The 2 charged have been accused of paying Medicaid recipients to submit false claims for HIV medication to the pharmacy. The pair’s alleged scheme focused a Medicaid-funded managed care group.

False psychotherapy companies: $2.5 million

A clinic proprietor in Illinois acquired a number of costs for allegedly committing almost $2.5 million in theft, forgery, and managed healthcare fraud. For shut to 2 years, the defendant supposedly submitted fraudulent claims price over $978,000 to 1 payer and over $1.5 million to a managed care group for psychotherapy companies that she by no means offered. This led the Illinois lawyer common to state, “Illinois’ Medicaid program serves 1000’s of residents who depend on Medicaid for his or her healthcare. I can’t tolerate people abusing this system and stealing vital funding for their very own monetary profit.”