The COVID-19 Fraud Enforcement Task Force was established in May 2021 to utilize the resources of the U.S. Department of Justice (DOJ) and various governmental agencies to combat COVID-19-related fraud. These efforts have led to investigations and prosecutions involving Paycheck Protection Program (PPP) fraud as well as healthcare-related COVID-19 fraud, the extent, and implications of which is only now becoming clear.

The DOJ is looking to cast a wide net around what it sees as healthcare-related COVID-19 fraud. Kevin Chambers, Director for COVID-19 enforcement for the DOJ, has described such coordinated efforts as “extraordinary” with the purpose being “to prosecute some of the largest and most-wide ranging pandemic frauds detected to date.”

At this writing, nearly two dozen defendants from across the U.S. have been charged for their alleged participation in such schemes. Federal law enforcement agencies that are involved include the Federal Bureau of Investigations, Department of Homeland Security; Department of Health and Human Services Office of the Inspector General, Food and Drug Administration Office of Criminal Investigations; and the Postal Inspection Service.

The subjects and targets of healthcare-related COVID-19 fraud cases vary from alleged bogus telemedicine encounters, to falsifying COVID-19 vaccination cards, to misuse of relief funds – and from medical professionals to manufacturers and distributors, respectively. In Florida, a medical professional was charged with healthcare fraud for allegedly billing bogus telemedicine encounters that did not legitimately occur during the pandemic. In California, a pharmacy director was accused of using actual vaccine lot numbers to falsify COVID-19 vaccination cards. Here in New Jersey, a postal service employee was charged with conspiracy for allegedly participating in a scheme to distribute fraudulent COVID-19 vaccination record cards to unvaccinated people. In Pennsylvania, an individual was charged with knowingly creating and possessing an unauthorized COVID-19 vaccination card, which bore an official government insignia.

Charges have also been brought against individuals for misappropriating the CARES Act Provider Relief Fund (PRF) monies meant to reimburse eligible medical providers for increased costs or lost revenue caused by the COVID-19 pandemic. An individual in California who owned and operated healthcare and hospice companies pleaded guilty to theft of government property because of his misuse of PRF monies, misappropriating nearly $200,000 worth of allocated PRF monies for personal use rather than for its intended purpose – to ensure continued relief and access to medical care. Moreover, the Center for Program Integrity, as a part of the Centers for Medicare & Medicaid Services has taken corresponding administrative actions against medical providers accused of such alleged wrongdoings.

It may become challenging for the government to discern between PPP loan borrowers that intended and affirmatively acted to commit fraud and those that were well-intentioned but nonetheless failed to comply with this fast-tracked federal relief program. As a result, many unwitting borrowers may find themselves caught in the DOJ’s fishnet of fraud charges. It is therefore critical for healthcare entities that received PPP funds to immediately review their compliance, mitigate any non-compliance, and address corrective measures and exposure to enforcement with the appropriate government agency. Moreover, healthcare providers, owners and executives of medical businesses, physicians, and healthcare marketers and manufacturers should keep careful track of their billing practices, including billing for telemedicine, and institute safeguards to ensure COVID-19 relief funds are not being intentionally or negligently misused.

 

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Photo of Rachel A. Frost Rachel A. Frost

Associate, Litigation and Healthcare Departments

Ms. Frost concentrates her practice in the areas of commercial and healthcare litigation, criminal defense, internal investigations, and regulatory compliance. She assists in the representation of numerous public and private business entities, private individuals, elected officials and candidates…

Associate, Litigation and Healthcare Departments

Ms. Frost concentrates her practice in the areas of commercial and healthcare litigation, criminal defense, internal investigations, and regulatory compliance. She assists in the representation of numerous public and private business entities, private individuals, elected officials and candidates for public office. Ms. Frost’s experience includes drafting discovery requests and responses, various pre-trial motions, briefs and other legal documents, researching complex legal issues, and attending depositions and pre-trial conferences.

Ms. Frost has prior experience in the practice areas of real estate and corporate transactions, redevelopment and land use, financial development and economic incentives, and related litigation.

Contact information:

rfrost@greenbaumlaw.com | 732.476.2470 | vCard  | LinkedIn

For more information visit the Greenbaum, Rowe, Smith & Davis LLP website.

Photo of Robert B. Hille Robert B. Hille

Partner, Healthcare and Litigation Departments

Mr. Hille focuses his practice in litigation, with a particular emphasis on trial advocacy. His areas of concentration include insurance, healthcare law, professional liability and ethics, and white-collar criminal matters, including those related to professional ethics. Mr. Hille…

Partner, Healthcare and Litigation Departments

Mr. Hille focuses his practice in litigation, with a particular emphasis on trial advocacy. His areas of concentration include insurance, healthcare law, professional liability and ethics, and white-collar criminal matters, including those related to professional ethics. Mr. Hille has extensive trial expertise that encompasses insurance defense and coverage cases, healthcare disputes, professional liability defense, fraud and abuse, and regulatory issues.

Mr. Hille’s white-collar experience includes involvement in both state and federal investigations, including those related to healthcare fraud and abuse and the taking of fraudulent payments from government entities. He also represents legal professionals in District Ethics Committee (DEC) and Office of Attorney Ethics (OAE) investigations and prosecutions, including matters before the Disciplinary Review Board (DRB) and New Jersey Supreme Court. In that regard, Mr. Hille has represented clients in matters ranging from dismissal or diversion to disbarment.

Certified by the Supreme Court of New Jersey as a Civil Trial Attorney, Mr. Hille has served as an amicus representative for professional and business associations on a number of matters before the Supreme Court. He has published and lectured widely in his areas of concentration.

Contact information:

rhille@greenbaumlaw.com | 973.577.1808 | vCard  | LinkedIn

For more information visit the Greenbaum, Rowe, Smith & Davis LLP website.

GRSD Healthcare Team

Healthcare Department

From regulatory issues to complex transactional and litigation matters to day-to-day business counseling, today’s healthcare industry faces a myriad of legal challenges that require the depth and breadth of a well-rounded and experienced team of professionals. The attorneys in the Healthcare…

Healthcare Department

From regulatory issues to complex transactional and litigation matters to day-to-day business counseling, today’s healthcare industry faces a myriad of legal challenges that require the depth and breadth of a well-rounded and experienced team of professionals. The attorneys in the Healthcare Department at Greenbaum, Rowe, Smith & Davis possess a sophisticated understanding of the unique healthcare business environment, both here in New Jersey and beyond.

The members of the firm’s healthcare team counsel a roster of clients that includes many of New Jersey’s foremost healthcare systems, hospitals and medical facilities, medical staffs, organized delivery systems (ODSs), clinically integrated networks (CINs), independent practice associations (IPAs), physicians and physician group practices, dentists and dental practices, physician and hospital-physician joint ventures, pharmaceutical companies, managed care organizations, home health agencies, nursing homes, behavioral health organizations, healthcare industry vendors, medical device manufacturers, management service organizations (MSOs), private equity firms, and industry-associated financial and corporate entities. This inclusive representation has propelled the team to statewide and national prominence within the healthcare field.

Our comprehensive healthcare practice encompasses numerous areas of focus. The attorneys in this practice area possess the requisite targeted expertise and hands-on experience to effectively represent a broad range of healthcare industry clients across a spectrum of legal concerns

Visit our website to contact the Healthcare Department.