Becker's Hospital Review

15 CFO / FINANCE 42 medical professionals among those charged in alleged $1.4B healthcare fraud By Alia Paavola T he Justice Department criminal- ly charged 138 people, including 42 medical professionals, for their alleged participation in healthcare schemes involving about $1.4 billion in fraudulent billings. e charges, announced Sept. 17, target about $1.1 billion in alleged fraud commit- ted using telemedicine, $29 million involv- ing alleged COVID-19 healthcare fraud, $133 million connected to substance use treatment facilities and $160 million in oth- er alleged healthcare fraud and illegal opioid distribution schemes. e Justice Department said it is charging 43 criminal defendants across 11 jurisdictions with telemedicine fraud schemes. Prosecu- tors claim that physicians and nurse practi- tioners ordered unnecessary equipment or medication for patients without interacting with them or only having a brief call with pa- tients they had never met or seen. Nine defendants were charged with allegedly engaging in healthcare fraud schemes "de- signed to exploit the COVID-19 pandemic." e Justice Department accused them of ex- ploiting Medicare's leniency during the public health emergency. e alleged fraud cases are being prosecuted by 31 U.S. attorneys' offices around the country. "is nationwide enforcement action demon- strates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain," said Kenneth Polite Jr., assistant attorney general of the Justice Department's Criminal Divi- sion. "e charges announced today send a clear deterrent message and should leave no doubt about the department's ongoing com- mitment to ensuring the safety of patients and the integrity of health care benefit pro- grams, even amid a continued pandemic." n Nearly 20% of previously unvaccinated Delta Air Lines employees have been vaccinated since insurance surcharge announcement By Kelly Gooch M ore Delta Air Lines workers have started the COVID-19 vaccination process after the compa- ny announced it would increase health insurance costs for its unvaccinated employees. Delta in August announced that its unvaccinated employ- ees would have to pay a $200 monthly health insurance surcharge, starting Nov. 1. Since then, Delta has seen nearly 20 percent of its previously 20,000 unvaccinated employees decide to get the vaccine, Delta Chief Health Officer Henry Ting, MD, said in an Infectious Disease Society of America briefing Sept. 9. As of Sept. 9, the surcharge announcement had resulted in raising Delta's vaccination rate from 74 percent to 78 per- cent of its 80,000 employees. The surcharge, announced Aug. 25, is "necessary to address the financial risk the decision to not vaccinate is creating for our company," Delta CEO Ed Bastian said in a memo to staff. The airline reported that the average cost for a COVID-19 hospital stay for the company has been $50,000. Dr. Ting said the company is "welcoming all those conver- sations to help our people make an informed decision." n CMS blocks 3 UnitedHealthcare Medicare Advantage plans from 6 states By Nick Moran C MS placed sanctions on three of UnitedHealth- care's Medicare Advantage plans, barring them from being sold in six states. The penalties come from a CMS oversight and enforce- ment group that found that between 2018 and 2020, the plans did not meet the 85 percent threshold of premium revenue spent on Medicare Advantage members, ac- cording to a Sept. 15 Star Tribune report. As a result, UnitedHealthcare cannot offer select Arkansas, New Mexico and Midwest plans to new members until 2023, assuming it hits the 85 percent threshold in 2022. Failure to hit the required threshold for five years in a row will result in the termination of the government contract. "UnitedHealthcare spends at least 85 percent of the pre- miums we take in on care for the people we serve," the company said in a statement to the Star Tribune. "In a few, we were not able to do that because so many of our members deferred going to get care due to COVID-19." The sanctions affect 86,000 members throughout six states, who can remain on their plans and receive in- creased benefits, according to the Star Tribune. Unit- edHealthcare's total Medicare Advantage enrollment is 7.5 million. n

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