DOJ recently announced a massive coordinated effort with other federal agencies to charge 345 defendants allegedly responsible for over $6 billion in fraud. DOJ, OIG, FBI, DEA, and various US Attorneys’ Offices in 51 federal districts teamed up to unveil charges against more than 100 doctors, nurses, and licensed clinical personnel. In its September 30 press release, DOJ asserts that the largest portion of the $6 billion in losses – 75% – is attributable to what it describes as “Telemedicine Fraud Cases.” At first blush, this is a headline-grabbing figure that suggests that the nascent Medicare telehealth industry is rife with fraudulent conduct. But, in peeling back the layers, are DOJ’s concerns really about telehealth or historic issues in healthcare and other industries?
The Antitrust Division of the US Department of Justice (DOJ) entered into a deferred prosecution agreement (DPA) with Florida Cancer Specialists & Research Institute LLC (FCS), a leading oncology provider in Southwest Florida, relating to allegations that FCS conspired to allocate medical and radiation oncology treatments for cancer patients with at least one other Florida oncology provider during a 17-year period.
The US government continues its focus on healthcare fraud through criminal actions. It has demonstrated its willingness to pursue physicians and investors alike and to take creative approaches in order to secure convictions. When it comes to alleged healthcare fraud, the government not only focuses on fraud in connection with government payers, but also uses the statutes in its arsenal to target purported fraud against private payers.
In recent remarks, Assistant US Attorney General Brian A. Benczkowski emphasized that the US Department of Justice remains serious about fighting corporate fraud and corruption, and noted that transparency in its criteria for prosecution is a key tool for both DOJ and private sector companies. Stressing the importance of effective compliance programs, he noted that companies are more likely to implement such programs when it is clear what conduct DOJ will credit or penalize.