The False Claims Act states that it is illegal for companies to knowingly submit fraudulent Medicare or Medicaid claims.
As both EHR implementation and telehealth use have expanded in the past few years, the Department of Justice (DOJ) has observed high levels of healthcare fraud, prompting the federal agency to increase its FCA enforcement.
The COVID-19 public health emergency led to a telehealth boom, but the DOJ has been investigating healthcare fraud involving the care modality since before the pandemic. Most of the DOJ cases involved false claims for durable medical equipment (DME) and compound medicine.
In 2019, the DOJ investigated an alleged fraud and kickback scheme in which DME companies paid illegal kickbacks to telehealth companies. The medical professionals working for the telehealth companies then referred Medicare beneficiaries to the DME companies for unnecessary back, shoulder, wrist, and knee braces.
The individuals involved with the telehealth companies and the DME company owners violated the False Claims Act, and the fraudulent Medicare billing led to a loss of more than $1.2 billion.
When the COVID-19 pandemic hit, Medicare introduced greater flexibility for telehealth coverage. Flexibility helped improve access to healthcare services for many individuals, but it also increased the opportunity for healthcare fraud and abuse, according to the lawyers. In response, the government upped its FCA enforcement.
In October 2020, the DOJ...
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