$6B in Healthcare Fraud Comes to Light

Late in September, the U.S. Department of Justice (DOJ)  charged 345 people with committing more than $6 billion in healthcare fraud, representing one of the largest healthcare fraud cases the federal agency has ever seen.  Many of the doctors, nurses, and other medical professionals involved were charged with filing false claims to both public and private insurance companies.

Many of the professionals charged with healthcare fraud allegedly ordered unnecessary medical tests, medications, or equipment without interacting with a patient or after only a brief telephone conversation. According to the DOJ, the telemedicine company executives charged in this case paid doctors, nurses, and other medical professionals to order the unnecessary treatments to increase profits and take advantage of healthcare benefit programs across the country. 


The national case, which spanned across 51 federal districts, was done jointly between the DOJ and the Department of Health and Human Services with assistance from the FBI, the DEA, and various U.S. attorney’s offices. After such a landmark fraud case that shook the industry, many are taking a closer look at the telemedicine industry as a whole. 

What is Telemedicine?

Telemedicine is generally regarded as real-time phone or video interactions, remote patient monitoring, or pre-saved video messages or images that are sent between medical professionals and patients. While it was previously utilized for general medical appointments, the COVID-19 pandemic led to a  sharp increase in the number of telemedicine appointments related to a multitude of medical ailments.

Seen as a great way to bridge the gaps between patients and medical care in urban, suburban, and even rural communities, telemedicine can be utilized for anything ranging from general check-ins, at-home heart monitoring, and even mental health care. Telemedicine fosters efficient, high-quality medical care when in-person options aren’t as available or possible, like during the current pandemic. 

What Does This Healthcare Fraud Case Mean for Telemedicine?

Unfortunately, the remote nature of telemedicine can also increase the ability for a medical professional to abuse the services and leverage aggressive medical marketing techniques to mislead patients and bolster the payments the medical professionals receive.  

This landmark case of $6 billion at its core looks to hold medical professionals and other health care benefit program exploiters accountable for their actions, which could have serious effects on the patients they are supposed to help. While $4.5 billion of the fraudulent claims to payers were connected to telemedicine schemes, around $800 million was related to substance abuse treatment and illegal opioid distribution – another large issue within the U.S. 

These many instances of fraud have prompted the Centers for Medicare and Medicaid Services, or CMS, to revoke Medicare billing privileges from 256 medical professionals who were connected to the telemedicine and healthcare fraud. This limits the services these professionals can offer, which further injures the already damaged communities and patients at the heart of these fraudulent claims.

Moving Forward From Healthcare Fraud

After the hundreds of charges relating to healthcare fraud, the DOJ announced that they are creating a new rapid response strike force intended to investigate fraud cases in the healthcare industry. This strike force will look at and monitor major providers in multiple jurisdictions in order to prevent something of this magnitude from happening again. 

With these charges reaching far and wide, the nationwide enforcement operation hopes to prevent the billions of dollars of exploitation that happened in previous years by ensuring that all healthcare and medical treatments are valid and reasonable. With such a large increase in telemedicine appointments in 2020 from the novel coronavirus pandemic, many anticipate that this could improve the quality of care many in the U.S. are depending upon during this difficult time.