The Drug Enforcement Administration (DEA) along with the FBI and other agencies, have recently taken down an incredible 345 defendants in 51 federal districts. According to the Department of Justice, the defendants “have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities.”
Also included in this ethical mess are more than $800 million associated with illegal opioid distribution.
Pandemic “Bums”
It is important to note that of the 345 defendants, more than 100 are physicians. It is also critical to understand that the current COVID-19 pandemic has not stopped, much less slowed the fraud, as much of the fraudulent activity was carried out courtesy of telemedicine.
Of the massive amount of fraud, the government uncovered, about $4.5 billion were physician claims submitted by nearly 90 “professional offices.”
According to the Department of Justice:
“Defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.”
If you are not outraged enough by this behavior, allegedly when fraudulent claims were submitted to Medicare, kickbacks and bribes were the norm. The investigations resulted in revoking the Medicare billing privileges of more that 250 physicians and nurse practitioners.
Task Forces – and so What?
The government has come up with a special, rapid task force specifically to go after telemedicine and other types of fraud in “a timelier manner.” But will that solve anything? It is doubtful. Every time we report medical fraud, it seems as though the next time around the amount of fraud get worse. The pandemic has not yielded less unethical behavior, but more.
What will solve problems is mandatory ethical training and the creation of more reliable oversite.
As we have seen above, fraudsters – and those willing to participate in fraud, have no compunction about taking bribes, “gifts” and kickbacks.
Despite the fact that the physicians and the nurse practitioners are among the most educated members of our society, a certain percentage will readily succumb to cash and gifts. We have witnessed that time and time again.
Under cover of a terrible pandemic, fraudsters have been able to use telemedicine to reach their client healthcare workers. They sold them on buying unnecessary equipment at huge profit or expensive tests or whatever, and then kicked money back. There was no oversite.
Why would a physician or nurse practitioner commit fraud? Greed. The need for money. In turn, the physicians convinced patients to get expensive tests and/or treatments that were billed to Medicare. The physicians, to make money, were complicit in a scam. We can talk about the Hippocratic oath, but bottom line is that they are unethical.
“Rationale,” the third element of fraud, is the most intriguing to me. The game is to take as much money as they can. Despite the protestations, investigations and legal actions of the government, this kind of behavior will continue because the government has no ethical screening.
All of the roads wind through Medicare. Why can’t there be an insistence on the part of the government that any medical office or hospital that bills Medicare must have yearly ethics training? What is to be lost? We are in an age of virtual training. Trained ethics experts can reach hundreds, if not thousands of healthcare providers.
Medicare fraud is not acceptable, but what is more troubling is that the healthcare providers put their unethical greed ahead of their patients. There can be no measure by which such providers should be allowed to practice.
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