Security & Fraud

Some COVID-19 Relief Funds Went To Healthcare Cos Under Scrutiny For Possible Fraud, Report Says

Some financial aid went to medical providers under criminal or civil investigation

The U.S. government’s massive payouts of financial aid to health care providers of Medicaid and other programs have inadvertently resulted in taxpayer dollars going to companies or individuals under criminal or civil legal investigation.

The payouts were reported by defense lawyers representing some of the firms and people at the center of the inquiries.

The Department of Health and Human Services, which distributed the funds, said the money went to any medical providers that submitted billings to Medicare except for some which had previously been excluded. Medicare is the federal health insurance program for the elderly and the disabled.

It is unknown what portion of the $30 billion allotted for medical aid went to those facing criminal or civil charges.

Reuters spoke with attorneys for several firms and individuals currently under either civil or criminal investigation. One was a pain medicine doctor who recently settled a civil case for false claims. Another was an assisted living facility operator who plans to plead guilty in a fraud case.

Legal experts know that being under investigation doesn’t necessarily mean these parties are guilty, and most are not barred from Medicare under normal circumstances for that reason — though people facing criminal health care charges typically agree to stop billing Medicare as a bond condition.

Attorneys have begun asking the clients in question to return the money they received, though.

The health care funding was sent out automatically, unlike the funds for small businesses which had to be applied for, and Joel Hirschhorn, an attorney representing some of the aforementioned clients, said “the left hand does not know what the right is doing” about the payments.

But Congressional Democratic leaders have not been happy.

Henry Connelly, a spokesman for House Speaker Nancy Pelosi, said: “It is alarming to see the Trump administration giving precious taxpayer dollars to unscrupulous entities while so many hospitals and health care workers on the frontlines of the battle against coronavirus are desperate for resources.”

In other cases of misappropriated stimulus money, the Department of Justice has also been looking into larger companies that received Paycheck Protection Program funding when they didn’t need it.

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New PYMNTS Report: Preventing Financial Crimes Playbook – July 2020 

Call it the great tug-of-war. Fraudsters are teaming up to form elaborate rings that work in sync to launch account takeovers. Chris Tremont, EVP at Radius Bank, tells PYMNTS that financial institutions (FIs) can beat such highly organized fraudsters at their own game. In the July 2020 Preventing Financial Crimes Playbook, Tremont lays out how.

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