Justice Department Announces Nationwide Coordinated Law Enforcement Action to Combat COVID-19 Health Care Fraud

Justice Division Declares Nationwide Coordinated Regulation Enforcement Motion to Fight COVID-19 Well being Care Fraud

LOS ANGELES The Division of Justice at this time introduced felony prices in opposition to 18 defendants in 9 federal districts throughout the US for his or her alleged participation in varied fraud schemes involving well being care providers that exploited the COVID-19 pandemic and allegedly resulted in over $490 million in COVID-19 associated false billings to federal packages and theft from federally funded pandemic packages.

Two of essentially the most important felony instances on this sweep had been filed by federal prosecutors within the Central District of California.

In reference to the enforcement motion, the division seized over $16 million in money and different fraud proceeds. The Heart for Program Integrity of the Facilities for Medicare & Medicaid Providers (CPI/CMS) individually introduced at this time that it took adversarial administrative actions within the final yr in opposition to 28 medical suppliers for his or her alleged involvement in COVID-19 schemes.

The Justice Division is not going to tolerate those that exploited the pandemic for private achieve and stole taxpayer {dollars}, mentioned Lawyer Normal Merrick B. Garland. This unprecedented enforcement motion in opposition to defendants throughout the nation makes clear that the Division is utilizing each accessible useful resource to fight and forestall COVID-19 associated fraud and safeguard the integrity of taxpayer-funded packages.

Todays announcement builds on the successes of the April 2022 COVID-19 Enforcement Motion and the Might 2021 COVID-19 Enforcement Motion and entails the prosecution of assorted COVID-19 well being care fraud schemes.

In one of the crucial important kinds of COVID-19 well being care fraud schemes introduced at this time, a number of defendants had been charged with defrauding the Well being Sources and Providers Administration (HRSA) COVID-19 Uninsured Program. The Uninsured Program was designed to forestall the additional unfold of the pandemic by offering entry to uninsured sufferers for testing and remedy. The Uninsured Program was additionally designed to supply monetary help to well being care suppliers preventing the COVID-19 pandemic by reimbursing them for providers offered to uninsured people. The Uninsured Program in the end ceased working because of the exhaustion of funding.

Within the Central District of California, a medical physician was charged for allegedly orchestrating an roughly $230 million fraud on the Uninsured Program.

Dr. Anthony Hao Dinh, 63, of Newport Coast, was the second highest biller within the nation to the Uninsured Program. On account of the scheme focusing on the Uninsured Program, Dr. Dinh and his firms had been paid greater than $153 million, and he used fraud proceeds for high-risk choices buying and selling, shedding over $100 million from November 2020 by February 2022, in response to courtroom paperwork.

Dr. Dinh allegedly submitted fraudulent claims for remedy of sufferers who had been insured, billed for providers that weren’t rendered, and billed for providers that weren’t medically essential, in response to a felony grievance filed on April 10.

After being arrested on April 12 and subsequently launched on a $7 million bond, Dr. Dinh is scheduled to be arraigned in United States District Court docket on Might 22. If he had been to be convicted of the three prices, Dr. Dinh would face a statutory most sentence of fifty years in federal jail.

Dr. Dinh is alleged to have stolen from a taxpayer-funded program meant to supply COVID-related well being care to uninsured sufferers, mentioned United States Lawyer Martin Estrada. We is not going to tolerate stealing from the American folks, and our prosecution of this large-scale scheme demonstrates our continued efforts to cease fraud of all types.

Dr. Dinh can be charged with two different people for allegedly submitting over 70 fraudulent mortgage functions beneath the Paycheck Safety Program (PPP) and Financial Damage Catastrophe Mortgage (EIDL) Program and fraudulently acquiring over $3 million in mortgage funds. The opposite defendants named on this scheme are Dr. Dinhs sister Cling Trinh Dinh, 64, of Lake Forest, who’s at present a fugitive being sought by federal authorities and Matthew Hoang Ho, 65, of Melbourne, Florida, who additionally was arrested on April 12. Dr. Dinh is charged within the grievance with well being care fraud and two counts of wire fraud. Cling Dinh and Matthew Ho are every charged with one rely of wire fraud.

The case in opposition to Dr. Dinh and his codefendants is being investigated by the U.S. Division of Well being and Human Providers Workplace of the Inspector Normal, the FBI, IRS Prison Investigation, the Division of Homeland Safety, Workplace of Inspector Normal, the Protection Prison Investigative Service, the AMTRAK Workplace of Inspector Normal, and the California Division of Well being Care Providers.

Assistant United States Lawyer Roger A. Hsieh of the Main Frauds Part, and Justice Division Trial Attorneys Justin M. Woodard and Helen H. Lee of the Fraud Part are prosecuting this case.

In one other case filed the Central District of California this one by attorneys with the Justice Departments Well being Care Fraud Strike Drive a lab proprietor was charged for allegedly submitting over $358 million in false and fraudulent claims to Medicare, HRSA, and a personal insurance coverage firm for laboratory testing. The indictment alleges that the defendants lab carried out COVID-19 screening testing for nursing properties and different amenities with weak aged populations, in addition to major and secondary faculties. However to extend its reimbursements, the defendant allegedly fraudulently added claims for respiratory pathogen panel checks though ordering suppliers and facility directors didn’t need or want them.

Lourdes Navarro, 64, of Glendale, was charged in a superseding indictment with conspiracy to commit well being care fraud and wire fraud, well being care fraud, conspiracy to commit cash laundering, and making false statements, in reference to the operation of Matias Medical Laboratory, Inc. (Matias), also called Well being Care Suppliers Laboratory, a laboratory she operated, managed, and managed along with her husband Imran Shams. Navarro was beforehand charged in an indictment returned in April 2022. The superseding indictment provides allegations that Navarro conspired with Shams and carried out a scheme to submit false and fraudulent claims to Medicare, the HRSAs COVID-19 Uninsured Program, and an insurance coverage firm for respiratory pathogen panel (RPP) testing that was not ordered, medically pointless, procured by unlawful kickbacks and bribes, and ineligible for reimbursement.

In the course of the COVID-19 pandemic, Matias carried out COVID-19 screening testing for quite a lot of purchasers, together with nursing properties, rehabilitation amenities, assisted dwelling amenities, and related amenities with weak aged populations, in addition to major and secondary faculties. It’s alleged that, in an effort to enhance its reimbursements, Matias fraudulently added claims for RPP checks though medical suppliers and facility directors didn’t get them organized, and such checks weren’t wanted for the affected person inhabitants Matias served. It’s additional alleged that Matias falsely represented to HRSA that sufferers had been identified with COVID-19 in an effort to receive cost on the RPP claims. The superseding indictment alleges further loss to Medicare, HRSA, and the insurer of roughly $241 million in billed claims, and alleges that these payors reimbursed Matias an extra $39.9 million. The case is being prosecuted by Trial Attorneys Gary Winters and Ray Beckering of the Nationwide Fast Response Strike Drive.

Todays announcement additionally consists of first-of-their-kind prices in opposition to suppliers of COVID-19 over-the-counter checks, which Medicare started to cowl in April 2022 for beneficiaries who requested them. These kits had been offered to the general public to gradual the unfold of the lethal illness, however wrongdoers allegedly sought to take advantage of this system by repeatedly supplying sufferers or, in some cases, deceased sufferers, with dozens of COVID-19 checks that they didn’t need or want. Within the Center District of Florida, a physician and a marketer had been charged for allegedly unlawfully buying Medicare beneficiary identification numbers and transport over-the-counter checks to beneficiaries all through the nation who didn’t request the checks, inflicting over $8.4 million in fraudulent claims to Medicare.

Expenses had been additionally introduced beneath the Well being Care Fraud Items Supplier Reduction Fund (PRF) Initiative. The PRF is a part of the Coronavirus Help, Reduction, and Financial Safety (CARES) Act, a federal legislation enacted in March 2020 that offered monetary help to medical suppliers to ship wanted medical care to People affected by COVID-19. Within the Jap District of Louisiana, the operator of a major care clinic and purported spa was charged with allegedly submitting fraudulent mortgage agreements, attestations, and different documentation from which she acquired over $1.1 million in PRF and EIDL funds that had been used to buy actual property, luxurious autos, a ship, a trailer, a time share, and luxurious holidays, amongst different expenditures. In complete, 12 defendants have been charged with crimes associated to misappropriating funds supposed for frontline medical suppliers, and 7 have pleaded responsible.

The legislation enforcement motion additionally consists of prices in opposition to producers and distributors of faux COVID-19 vaccination report playing cards, who deliberately sought to hinder the Division of Well being and Human Providers (HHS) and Facilities for Illness Management and Prevention (CDC) of their efforts to manage the nationwide vaccination program and supply People with correct proof of vaccination. Within the Jap District of New York, three medical professionals who labored at a small midwife apply had been charged for allegedly distributing almost 2,700 cast COVID-19 vaccination report playing cards to people who weren’t vaccinated. As an alternative of administering the COVID-19 vaccine, the defendants allegedly destroyed vials of COVID-19 vaccines that had been supposed for use to inoculate sufferers. Regardless of being a small midwife apply, it was one of many busiest vaccination websites in New York State, outpacing massive, state-run vaccination websites. Within the District of Utah, two people had been charged for allegedly manufacturing and promoting on-line roughly 120,000 counterfeit COVID-19 vaccination report playing cards throughout the nation, particularly in areas that had been topic to extra stringent COVID-19 vaccine restrictions.

Todays enforcement motion was led and coordinated by the Fraud Part within the Justice Departments Prison Division. The Well being Care Fraud Items Strike Forces in Brooklyn, the Gulf Coast, Los Angeles, and Tampa; the Nationwide Fast Response Strike Drive; and the U.S. Attorneys Workplaces for the Central District of California, Center District of Florida, Jap District of Louisiana, Center District of Louisiana, Western District of Louisiana, Jap District of New York, District of Puerto Rico, District of Utah, and Western District of Washington are prosecuting these instances, with help from the Well being Care Fraud Items Knowledge Analytics Workforce. Descriptions of every case concerned in todays enforcement motion can be found on the departments web site at www.justice.gov/criminal-fraud/health-care-fraud-unit/2023-case-summaries.

Along with the FBI and HHS-OIG, the Small Enterprise Administration Workplace of Inspector Normal, Protection Prison Investigative Service, Inner Income Service Prison Investigation, Treasury Inspector Normal for Tax Administration, Homeland Safety Investigations, Division of Homeland Safety Workplace of Inspector Normal; Division of Protection Workplace of Inspector Normal, AMTRAK Workplace of Inspector Normal, California Division of Well being Care Providers, and different federal and state legislation enforcement companies participated within the legislation enforcement motion.

The Well being Care Fraud Strike Drive is a part of a joint initiative between the Division of Justice and HHS to forestall and deter well being care fraud and implement present anti-fraud legal guidelines across the nation. Up to now three years, the Well being Care Fraud Strike Drive has rooted out well being care fraud associated to the COVID-19 pandemic. Thus far, 53 defendants have been charged in nationwide COVID-19 Well being Care Fraud Enforcement Actions for inflicting over $784 million in loss related to the pandemic, and 20 defendants have been convicted.

On Might 17, 2021, the Lawyer Normal established the COVID-19 Fraud Enforcement Activity Drive to marshal the assets of the Division of Justice in partnership with companies throughout authorities to boost efforts to fight and forestall pandemic-related fraud. The Activity Drive bolsters efforts to analyze and prosecute essentially the most culpable home and worldwide felony actors and assists companies tasked with administering reduction packages to forestall fraud by, amongst different strategies, augmenting and incorporating current coordination mechanisms, figuring out assets and methods to uncover fraudulent actors and their schemes, and sharing and harnessing info and insights gained from prior enforcement efforts. For extra info on the departments response to the pandemic, please go to www.justice.gov/coronavirus.

The Division of Justice wants the publics help in remaining vigilant and reporting suspected fraudulent exercise. To report suspected fraud, contact the Nationwide Heart for Catastrophe Fraud (NCDF) at (866) 720-5721 or file an internet grievance at www.justice.gov/disaster-fraud/webform/ncdf-disaster-complaint-form. Complaints filed will probably be reviewed on the NCDF and referred to federal, state, native, or worldwide legislation enforcement or regulatory companies for investigation.

An indictment, grievance, or info is merely an allegation. All defendants are presumed harmless till confirmed responsible past an inexpensive doubt in a courtroom of legislation.

Author: ZeroToHero

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