Recent enforcement actions involving the health care industry dealt with a variety of different kinds of fraud, including kickbacks, money laundering, fraudulent billing, and a fake COVID-19 vaccination card operation. Here’s a quick summary of the cases:
May 10: Two owners of Phoenix-based telemedicine company RediDoc LLC pleaded guilty for their involvement in a $64 million health care fraud scheme that involved paying bribes to doctors and fraudulently billing Medicare and TRICARE. They each pleaded guilty for one count of conspiracy to commit health care fraud and one count of conspiracy to violate the federal Anti-Kickback statute, according to the U.S. Department of Justice (DOJ). Each owner faces up to five years in prison for the kickback charges and as many as 10 years in prison for the health care fraud charges. In addition, both counts also carry fines, restitution, and forfeiture penalties. The owners are set to be sentenced in October, according to the DOJ.1
May 12: The owner of a now shuttered clinic in Garden City, Georgia, was sentenced to prison after pleading guilty for her involvement in a money laundering scheme connected to a “pill mill” doctor who has already been sentenced to prison and asked to pay hundreds of thousands of dollars in restitution for illegally dispensing huge amounts of drugs. According to the DOJ, the defendant’s clinic, Georgia Laboratory Diagnostics LLC, provided a base of operations for the doctor’s dispensing scheme. She now faces 60 months in prison with no chance of parole, must pay $86,074 in restitution, and serve three years of supervised release after her time in prison.2
May 12: A physician practicing in two locations in Ohio was charged for his role in an $8.4 million fraudulent billing scheme. According to the DOJ, the physician allegedly billed Medicare for medically unnecessary durable medical equipment, prosthetics/orthotics, and supplies (DMEPOS) using information collected from Medicare beneficiaries via call centers and telemarketers.3
May 12: The U.S. District Court for the Southern District of Ohio took steps to shut down an alleged operation involving a Columbus-area woman who produced and sold fake Centers for Disease Control and Prevention (CDC) COVID-19 vaccination cards. According to a DOJ statement, the court “entered a consent decree permanently enjoining” the woman from making and selling the cards, which she had apparently advertised on her blog for a cost of $40 each, allegedly selling nearly 80 fake cards.4