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Rise of Telehealth Fraud in the Healthcare Industry

In July 2022, the Department of Justice (DOJ) announced criminal charges against 36 defendants for committing a variety of alleged schemes to defraud Medicare using telehealth. According to the DOJ, the alleged actions of the defendants led to $1.2 billion in medical fraud, with much of that coming from fraudulent telehealth claims for cardiovascular and cancer genetic testing and unnecessary durable medical equipment (DME).

Telehealth is the latest type of fraud to emerge in the healthcare industry. While telehealth made it possible for patients to receive healthcare during the pandemic, widespread use and lenient restrictions have made it a target for fraud and abuse. In this article, we discuss the different types of telehealth fraud we’re seeing in the healthcare industry.

Types of Fraudulent Telehealth Schemes

Telehealth fraud can take a variety of different forms, ranging from false claims from inaccurate billing or coding to complex kickback schemes. Here are some fraudulent schemes involving telehealth.

  • Billing Medicare for unnecessary durable medical equipment (DME)
  • False billing or coding for medical treatment and services
  • Kickbacks paid to doctors or others to get referrals for healthcare services or treatment in violation of the Anti-Kickback Statute
  • Unnecessary or excessive prescriptions, especially opioid prescriptions. Unnecessary or non-existent screening tests for cancer and other conditions

How to Report Telehealth Fraud: What You Can Do

If you suspect fraudulent telehealth schemes or have seen signs that indicate telehealth abuse, it’s important to gather as much information. The information you provide will help your legal team build a stronger case. Here are just a few items to consider when documenting data and information:

  • Names of important players: doctors, pharmaceutical representatives, lab facilities
  • Names of drugs or treatments being off-labeled, marketed, abused, or misused
  • Any websites, phone numbers, or cell phone data associated with the fraudulent activity
  • Copies of documents used to record and solicit information
  • Knowledge or evidence of false medicare claims
  • Nature of any kickbacks exchanged: how were the parties compensated
  • Knowledge of lead generation/targeting practices
  • Failure of medical facilities to uphold patient care

The signs of telehealth fraud are varied and sometimes tailored to fit specific drugs, treatments, or illegal goals. You can explore more examples of allegations and how to report fraud on our website. It’s essential to gather information carefully.

Become a Whistleblower

Whether you’re a telehealth patient, healthcare worker, or simply have information about healthcare providers attempting to defraud public funds, you may be eligible to become a whistleblower.

DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can bring fraud to light.

If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

If you have valuable information that can help expose fraud, we encourage you to speak to our experts. We will be there every step of the way to ensure you are safe and your information is confidential so you will have confidence knowing you’re doing the right thing. Contact us today.

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Top Three Healthcare Fraud and False Claims Recoveries of 2021

Fraud in the healthcare sector continues to be a major concern in the United States. According to the Health Care Fraud and Abuse Control Program Annual Report, healthcare fraud was by far the leading source of the False Claims Act settlements and judgments in 2021. In fact, more than $5 billion of the $5.6 billion collected in federal false claims and fraud cases involved healthcare industry entities–the department’s largest haul since 2014.

Healthcare fraud affects everyone. Reduced benefits, higher out-of-pocket costs, unnecessary procedures, and higher taxes are just a few of the consequences that occur when an individual or organization commits healthcare fraud. Whistleblowers must stay vigilant and report any suspicions. Here are the top three fraud and False Claim recoveries from 2021.

  1. $447.2 Million: Taro Pharmaceuticals USA, Inc., Sandoz Inc., and Apotex Corporation

In October 2021, three generic pharmaceutical manufacturers, Taro Pharmaceuticals USA, Inc., Sandoz Inc., and Apotex Corporation, agreed to pay a total of $447.2 million to resolve alleged violations of the False Claims Act arising from conspiracies to fix the price of various generic drugs. The Justice Department alleged that these conspiracies resulted in higher drug prices for federal healthcare programs and beneficiaries. According to the DOJ, all three manufacturers violated the Anti-Kickback Statute due to arrangements on price, supply, and allocation of customers with other pharmaceutical manufacturers of various generic drugs.

  1. $300 Million: Indivior

In April 2021, pharmaceutical manufacturer, Indivior, agreed to pay $300 million to resolve claims that it falsely and aggressively marketed its opioid addiction drug, Suboxone, resulting in improper use of state Medicaid funds. According to the DOJ, Indivior promoted the sale and use of Suboxone for unsafe, ineffective, and medically unnecessary purposes, including by claiming it was less susceptible to abuse. Additionally, the company took steps to fraudulently delay the entry of generic alternatives in order to control pricing. This settlement resolves six whistleblower suits pending in New Jersey and Virginia under the qui tam, or whistleblower, provision of the False Claims Act, which allows private citizens to bring civil actions on behalf of the United States and share in any recovery.

  1. Alere: $160 Million

In August 2021, diabetic testing supply company, Arriva Medical LLC and its parent company Alere Inc. agreed to pay $160 million to resolve allegations that the two companies made, or caused, claims to Medicare that were false. According to the settlement, Arriva, with Alere’s approval, regularly waived or simply didn’t collect Medicare copayments and sent new glucose meters at no cost to patients who weren’t yet eligible for reimbursable upgrades. The whistleblower, in this case, was an employee at an Arriva call center and is set to receive a whistleblower award of $28.5 million. 

These are just a few of the countless settlements that occurred in 2021. When corruption finds its way into the healthcare industry, it can be easy for these multi-billion dollar companies to take advantage of the system. As a result, consumers, healthcare systems, and government entities suffer the consequences of healthcare fraud that leads to diminished patient care, mistrust in the healthcare system, and misappropriation of publicly funded healthcare.

Our goal at DJO is to expose and report healthcare fraud wherever and whenever possible. We work with individuals to gain information, build a case, and fight for taxpayers’ justice. In doing so, we can protect the vulnerable and make the world a safer place.

If you suspect healthcare fraud in your organization, please contact us. DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can expose fraud. If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination. Do you have valuable information that can help bring fraud to light? Speak to our experts today.

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Pharmaceutical Fraud: Reporting Illegal Kickbacks

Pharmaceutical fraud exists in many ways. However, one of the most common tactics used in the industry is illegal kickbacks.

Kickbacks are anything of value either directly or indirectly offered to a patient or physician that influences their medical decision to use a certain company or product. This action constitutes fraud because it undermines the ethics of our medical community.

When big pharma gives illegal kickbacks to physicians, it undermines the integrity of Federal Healthcare Programs. In this article, we analyze a recent case where whistleblowers played a significant role in reporting kickbacks paid by a pharmaceutical distributor.

Former Sales Rep Gets $109M for Blowing the Whistle on Doctor Kickbacks

In July of 2020, Novartis Pharmaceuticals Corporation agreed to pay $678 million in separate settlements to resolve claims the drugmaker violated the False Claims Act and the Anti-Kickback Statute. According to the DOJ, Novartis set up sham speaker programs as venues for paying physicians kickbacks to boost scripts of its drugs Lotrel, Valturna, Starlix, Tekturna, Tekamlo, Diovan, and Exforge. These events often involved lavish meals, fishing trips, and other entertainment.

The Anti-Kickback Statute prohibits anyone from offering or paying, directly or indirectly, anything of value, in an effort to induce or reward the referral of business covered by Medicare, Medicaid, and other federally funded programs. Novartis was accused of violating the federal Anti-Kickback Statute by offering payment to healthcare practitioners in the form of cash, meals, and honoraria to encourage them to prescribe certain Novartis drug products.

The settlement resolves a whistleblower lawsuit filed by a former Novartis sales representative under the FCA in 2011. According to reports, law enforcement asked the whistleblower to wear a wire to record several bribes he paid to doctors.

As a result, Novartis agreed to pay $591 million to the United States as False Claims Act damages, $38.4 million to the United States as proceeds for violations of the Anti-Kickback Statute, and the remaining $48 million to various states to resolve Medicaid claims. The whistleblower in this case is set to receive a reward of  $109.4 million for his involvement in the case.

Do You Have Valuable Information That Can Lead to Exposing Fraud in the Pharmaceutical Industry?

Whistleblower law firms like DJO want to put an end to pharmaceutical fraud tactics that hurt consumers. DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can bring fraud to light.

If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

DJO will be there every step of the way to ensure you are safe and your information is confidential so you will have confidence knowing you’re doing the right thing. If you have valuable information that can help expose fraud, we encourage you to speak to our experts today.

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Blowing the Whistle on Healthcare Fraud: What You Need to Know

Healthcare fraud is a costly crime that affects both individuals and businesses alike. Unfortunately, scams like upcoding, double billing, and kickbacks are significant in the industry, costing the nation billions of dollars each year. It can increase taxes, expose people to unnecessary medical procedures and raise insurance premiums.

The best way to fight fraud is to expose the individuals and organizations committing these crimes. Whistleblowers play a major role in stopping healthcare fraud and may be eligible for a reward by bringing a case under the federal False Claims Act. However, identifying and reporting fraud is not always easy. This article gives you what you need to know about blowing the whistle on healthcare fraud.

Who Commits Healthcare Fraud?

Healthcare fraud is committed by both medical professionals and organizations. These include:

  • Hospitals
  • Home Health and Hospice Organizations and Providers
  • Laboratories and Diagnostic Testing Facilities
  • Managed Care Organizations
  • Medical Device and Durable Medical Equipment (DME) Manufacturers and Distributors
  • Pharmaceutical Organizations
  • Medical Providers
  • Skilled Nursing Facilities

Types Healthcare Fraud

There are many kinds of fraudulent activities that could occur in the healthcare sector. Some examples of frauds and scams in the healthcare industry include:

  • Violation of laws prohibiting kickbacks and certain financial arrangements
  • Upcoding
  • Risk adjustment fraud by Managed Care Insurance Companies
  • Unbundling of services or procedures
  • Billing for services not provided
  • Billing for services that are not medically necessary
  • Billing for unlicensed personnel
  • Billing for unauthorized locations
  • Electronic health record (EHR) fraud
  • Off-label marketing of prescription drugs
  • Defective products and manufacturing violations
  • Discount/rebate and other pricing fraud
  • Clinical trial/FDA fraud
  • Compounding pharmacy fraud

What To Do if You Spot Healthcare Fraud

If you suspect healthcare fraud or have seen signs that indicate fraudulent activity, you should document your complaint in writing with as much detail as possible. Keep documentation as objective as possible, stating only facts and actions. Then, carefully monitor the situation for paperwork, emails, texts, transactions, or conversations that could prove a violation of the False Claims Act or other compliance regulations.

The next best course of action is to consult a law group with attorneys who specialize in blowing the whistle on healthcare fraud. They can help you determine if you have a good case and what would be the best course of action.

Help Blow the Whistle on Healthcare Fraud

The dark side of the healthcare industry has immense impacts on our society. Consumers, healthcare systems, and government entities suffer the consequences of healthcare frauds that lead to diminished patient care, mistrust in the healthcare system, and misappropriation of publicly funded healthcare.

Our goal at DJO is to expose healthcare fraud wherever and whenever possible. We work with individuals to gain information, build a case, and fight for taxpayers’ justice. In doing so, we can protect the vulnerable and make the world a safer place.

If you suspect healthcare fraud in your organization, please contact us. DJO is comprised of a highly experienced team of whistleblower experts, lawyers, and even former whistleblowers, who strive to deliver the highest monetary reward for brave individuals who have valuable information that can expose fraud. If a whistleblower’s lawsuit is successful, the reward can be between 15% to 25% of the funds recovered. The False Claims Act also offers whistleblowers protection against job retaliation or wrongful termination.

Do you have valuable information that can help bring fraud to light? Speak to our experts today.