September 28, 2021

Volume XI, Number 271

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September 27, 2021

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Federal Authorities Ramping Up COVID-19 Related Health Care Fraud Prosecutions

Recently announced Department of Justice (DOJ) priorities include a reinvigoration of health care fraud prosecutions. The COVID-19 crisis created fertile ground for not only fraud related to the Paycheck Protection Program (PPP) but recent announcements make crystal clear that enforcement of health care fraud arising from COVID-19 related schemes also has a high priority.

With billions in government funds at stake, only the human imagination limited potential fraud possibilities. The DOJ has formed the COVID-19 Interagency Working Group as part of the Health Care Fraud Unit. Individual executives and business entities were targeted for criminal prosecution for violations relating to telehealth billings, COVID-19 testing, improper test bundling, and overbilling, among other COVID-19 related schemes. Like PPP fraud allegations, many of the health care fraud allegations relate to attempts to take advantage of limited government oversight given the massive sums of money and relative speed of the new funding.

While the prosecution of civil and criminal health care fraud violations is not new, the COVID-19 crisis exponentially increased the fraud exposure. Health care providers and contractors should pay particular attention to COVID-19 related billings and procedures to ensure compliance. Self-audits and compliance checks are just two actions that can be taken to minimize the risks of liability.

Examples of some precautionary steps which could prevent fraud include:

  • Create or review internal controls, such as spot audits on billings to Medicare, to assure proper coding and medical need.

  • Implement and enforce internal policies and procedures so that all team members know what is required and what the penalties are for improper conduct.

  • Perform due diligence background checks of contractors hired to support billing or testing. For example, checking whether or not an entity has been excluded from federal health care programs is easily done as the U.S. Department of Health and Human Resources provides online searchable databases to identify those who have been excluded.

  • Careful supervision of any bundling of COVID-19 testing with other testing.

  • Be alert for use of “emergency override” billing to avoid pre-authorization requirements.

© Steptoe & Johnson PLLC. All Rights Reserved.National Law Review, Volume XI, Number 161
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About this Author

William J. Powell Civil Defense Lawyer Steptoe Johnson
Of Counsel

Clients appreciate that Bill Powell is a straightforward attorney who cuts through the fluff and gets to the heart of the matter.  Bill’s pragmatic nature has been an asset to private clients for more than three decades and made him an effective United States Attorney who actively sought justice in high-stakes criminal activities, including drug conspiracies, national security matters, murder and other violent crime, and major fraud cases. 

Bill has a unique skill set that is a combination of bet-the-company civil defense and high profile prosecution.  The common denominator in his...

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