A physician in Washington state pled guilty on September 28, 2022, to a criminal charge of conspiring to accept kickbacks related to fraudulent genetic testing. According to the Department of Justice (DOJ), the physician ordered certain genetic testing for Medicare beneficiaries that he was not treating and with whom a physician-patient relationship was not established as part of the scheme. According to the plea agreement accepted by the physician, the physician would be connected by telemarketers to the beneficiaries for a few minutes, the physician would order the diagnostic test, the labs would then bill for the test, and another company billed Medicare for the purported telemedicine visit. The physician received almost $168,000 in kickbacks for ordering the medically-unnecessary testing and other services, which resulted in over $18 million being paid by Medicare.
This is the most recent case in a string of DOJ enforcement actions in connection with “purported telemedicine companies,” which were the subject of a Special Fraud Alert issued in July 2022 and discussed in a prior Health Law Diagnosis post. Other enforcement actions have similarly targeted providers, including a case in which a nurse recruited physicians and other healthcare providers to sign orders and purported to have a team of nurses working to contact patients to conduct telemedicine exams on behalf of physicians in exchange for ordering medical equipment and expensive genetic testing for the patients. Another recent criminal case arose from a scheme involving illegal kickbacks to physicians and marketers to induce the ordering of bundled COVID-19 testing and allergy testing. [view related]
These cases demonstrate the government’s continued focus on investigating and prosecuting fraud and abuse related to the misuse of telehealth services, particularly during the COVID-19 pandemic. We will continue to monitor enforcement developments affecting providers and other health care organizations.