Nearly 500 people have been charged by the US Justice Department after a two-week healthcare fraud crackdown that officials say involved more than $6.5bn in false claims submitted to insurers, reports AP.
Among the 455 facing criminal charges is a nurse practitioner who allegedly billed Medicare for unnecessary wound-care procedures and blew the proceeds on fancy jewellery and luxury cars; a mental health company owner who apparently targeted the homeless by billing for crisis stabilisation services they did not receive; and a hospice owner alleged to have paid kickbacks to a funeral home employee for information about deceased Medicare beneficiaries.
A heart doctor in Florida, meanwhile, has been linked to an $89m fraud scheme, accused of billing insurers for unnecessary cardiovascular screening tests for college student-athletes and then rubber-stamping the results as normal without personally reviewing them.
The doctor, Jason Finkelstein, faces charges of healthcare fraud and conspiracy in what prosecutors describe as a years-long scheme that preyed on the fears of athletes that they might die on playing fields or courts of sudden cardiac arrest.
Athletes with no pre-existing conditions who were concerned about being cleared to compete were administered tests they did not need and, in one case, a patient whose results were falsely certified as normal later died after his significant heart problems were undetected, the indictment says.
A lawyer for Finkelstein, who pleaded not guilty during a court appearance last week, did not return calls from The Associated Press.
The alleged fraud ran between 2019 and the end of last year and, apparently involved Finkelstein and a pair of unidentified co-conspirators at a Florida-based cardiovascular testing and treatment practice where he served as medical director
Officials say the scheme had multiple components, with Finkelstein and his company using what the indictment says were deceptive marketing tactics to encourage and offer free heart screening for students who did not need them and then certifying the results as normal without any review.
The indictment quotes Finkelstein as telling an unnamed co-conspirator with whom he worked that “these kids could be high risk ..one of them drops dead on a field, then they’re coming after both of us”.
Finkelstein’s co-conspirators blasted out emails to athletic trainers at colleges and universities saying the tests being offered could identify any life-threatening condition that might prevent the students from playing.
They also offered kickbacks and other inducements to school officials to refer potential patients for testing, according to the indictment.
Insurance companies do not cover blanket cardiovascular testing but instead require a prior finding of a medical necessity. To avert that roadblock, prosecutors say, Finkelstein submitted to insurers phoney diagnoses of conditions. like elevated blood pressure and hypertension, that the athletes did not actually have.
His company relied on sonographers, who lacked the requisite credentials, to travel to campuses to perform the tests, and because Finkelstein was licensed in the 48 contiguous states, he and his company were able to submit claims for patients countrywide, the indictment says.
At the same time, he would certify cardiac test results as being normal without actually reviewing them.
In one instance in 2024, according to the indictment, he signed off on 63 test result images of one patient just 11 seconds after accessing them. The test results actually revealed a significantly enlarged heart and the teenage patient later died on the basketball court.
“There is no way they could miss that, except they didn’t care,” said Mehmet Oz, a cardiothoracic surgeon and Head of the Centres for Medicare & Medicaid Services. “This is not a diagnostic company. It’s a predatory scheme dressed up in medical clothing and we’re going to treat it as such.”
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