Thursday, August 18, 2022

DOJ Releases Bonanza of "Telemedicine Fraud" Documents, Most Implicate Genetics and Novitas MAC Payments

The Department of Justice has recently released a treasure trove of indictments and related documents under the umbrella of "telemedicine fraud."

However, the reader will quickly note, the problem isn't the "telemedicine."  They aren't worried about the costs of a $45 telemedicine call.  They are worried that the calls would result in $10,000 of improper genetic test orders, one after another.  Some cases involved DME rather than genetics.

See a DOJ project home page here:

https://www.justice.gov/criminal-fraud/telemedicine-enforcement-action

See a July 20 2022 press release here:

https://www.justice.gov/opa/pr/justice-department-charges-dozens-12-billion-health-care-fraud

Of special interest, see the couple dozen court documents here:

https://www.justice.gov/criminal-fraud/telemedicine-court-documents

Once you identify names of labs from the court documents, in a few seconds you can look up that lab's 2020 payments from Medicare:

http://www.discoveriesinhealthpolicy.com/2022/07/medicare-releases-detailed-database-for.html

CMS Cloud data CY2020 here, which went live on July 27, just 7 days after the DOJ postings.

https://data.cms.gov/provider-summary-by-type-of-service/medicare-physician-other-practitioners/medicare-physician-other-practitioners-by-provider-and-service

Even easier, see a ready to use 3400 line spreadsheet of all Medicare's 2020 payments for genetic test codes (811nn 812nn 813nn 814nn 815nn):

https://docs.google.com/spreadsheets/d/10HIXvrIPx1DA9EW7Loh0zZ3OKUyR59bR/edit#gid=1860210251

See a 3 minute video about the websites:

https://www.youtube.com/watch?v=LQ4URECsQ9s


click to enlarge