COVID-19 Fraud

The federal government is broadening its multi-agency law enforcement effort to address pandemic-related fraud beyond Paycheck Protection Program (PPP) related cases to encompass alleged instances of healthcare-related COVID-19 fraud. The subjects and targets of these investigations and prosecutions include alleged Bogus Telemedicine Encounters, falsifying COVID-19 vaccination cards, and the misuse of healthcare provider relief funds by medical professionals, manufacturers, distributors, and others. Healthcare providers, healthcare business owners, and healthcare marketers and manufacturers should keep careful track of all billing practices, including those related to telemedicine, and should institute appropriate safeguards to ensure that COVID-19 relief funds are not being intentionally or negligently misused

Examples of COVID-19 Fraud

The list of U.S. Department of Justice (DOJ) investigations and prosecutions has continued to grow and expand beyond PPP-related cases. To date, nearly two dozen defendants from across the U.S. have been charged for their alleged participation in such schemes. The subjects and targets of these cases vary from alleged bogus telemedicine encounters to falsifying COVID-19 vaccination cards, to misuse of relief funds, and from medical professionals to manufacturers and distributors, respectively. Some of the examples of such fraud include: 

• In a case out of the Southern District of Florida, a medical professional was charged with healthcare fraud for allegedly billing bogus telemedicine encounters that did not legitimately occur during the pandemic. 
• In another case out of the Northern District of California, a pharmacy director was accused of using actual vaccine lot numbers to falsify COVID-19 vaccination cards. 
• In yet another case out of the District of New Jersey, a Postal Service employee was charged with conspiracy for allegedly participating in a scheme to distribute fraudulent COVID-19 vaccination record cards to unvaccinated people. 
• Most recently, in the Middle District of Pennsylvania, an individual was charged with knowingly creating and possessing an unauthorized COVID-19 vaccination card that bore an official government insignia, and in the Eastern District of North Carolina, a lawyer pled guilty and was ordered to forfeit over $2 million as a result of being involved in a fraudulent assistance loans scheme that funded her plastic surgery and several vacation homes, including one in Miami.
• In the Northern District of California, an individual who owned and operated healthcare and hospice companies pleaded guilty to theft of government property because of his misuse of PRF monies. In that case, the individual misappropriated nearly $200,000 worth of allocated PRF monies for personal use rather than for its intended purpose, to ensure continued relief and access to medical care. Moreover, the Center for Program Integrity, as a part of the Centers for Medicare & Medicaid Services (CPI/CMS), has taken corresponding administrative actions against medical providers accused of such alleged wrongdoings.

Healthcare providers, group practices, billing teams of medical businesses, and physicians should keep careful track of their billing practices, including billing for telemedicine, and should institute appropriate safeguards to ensure that COVID-19 relief funds are not being intentionally or negligently misused. You can refer to the original document “DOJ and Federal Law Enforcement Agencies Coordinate Efforts in Expanded Pursuit of Healthcare-Related COVID-19 Fraud” for detailed information. MedicalBillersandCoders (MBC) is a leading revenue cycle company providing complete medical billing services. We can assist you in receiving accurate insurance reimbursement while following billing guidelines and payer reimbursement policies. In case of any assistance is needed for medical billing and coding for your practice, contact us at [email protected] / 888-357-3226