The Department of Justice just announced a criminal indictment against 36 defendants in 13 federal districts claiming $1.3 Billion in healthcare fraud, one of highest-ticket actions. What’s targeted? Telemedicine (and marketing) involved in cardiovascular, genetic testing and DME. Again!
DME was last targeted in a such a huge way back in 2016 in connection with Operation Brace Yourself (over $900M in alleged healthcare fraud). Ill-conceived relationships between DME providers, CGx labs and marketing companies have been a mainstay of federal criminal enforcement action by the Medicare Fraud Strike Force for years now, most recently in 2021 with Operation Happy Clickers, a $7M action against DME and CGx providers.
It’s curious why people rush into the deep waters of such relationships when the “cure” for it is widely known—thoroughly documented medical necessity. Add to that proper structuring of marketing and telemed relationships (that fit squarely into the bona fide employee exception and/or the applicable safe harbor). By now, businesspeople and healthcare professionals have ample defined lines when structuring and operationalizing legitimate relationships and the OIG has the ability to examine them all.