A federal jury recently convicted a pharmacy owner for a fraud scheme that entailed more than $174 million in claims paid by private insurers, Medicare, and TRICARE. As with similar recent cases, the pharmacy owner contracted with a telemarketer to recruit patients. The telemarketer then used their platform as a telemedicine service, with physicians remotely prescribing medicines based solely on the telemarketer’s information. The pharmacy owner then maximized insurance payments by picking and choosing which prescription medications he submitted to Pharmacy Benefit Managers (PBM) for reimbursement. Moreover, according to evidence presented at trial, the medications were typically unnecessary, and patients were deceived into providing their insurance information.
Earlier this year, the Department of Health and Human Services Office of Inspector General (HHS OIG) announced that in its 2020 National Health Care Fraud Takedown, $4.5 billion of the more than $6 billion in alleged fraud losses was due to telemedicine schemes. Telemedicine fraud is ripe for False Claims Act enforcement.
Earlier in 2021, the HHS Principal Deputy Inspector General released a statement where she emphasized that the agency “will continue to vigilantly pursue these ‘telefraud’ schemes and monitor the evolution of scams that may relate to telehealth.” In discussing telemedicine, the Principal Deputy Inspector General recently cautioned that “it is important that new policies and technologies with the...
PORTLAND, Ore. - Two men face federal charges for allegedly defrauding Medicare, the Department of Health and Human Services, the Veterans Health Administration and private insurance companies out...