The Government’s coronavirus assistance includes trillions of dollars in loans and other economic support for hospitals, health organizations, and medical providers. Given the massive scale of the COVID-19 assistance, the potential for fraud is enormous.
The Provider Relief Funds supports American families, workers, and the heroic healthcare providers in the battle against the COVID-19 outbreak. Funds are provided to make sure that uninsured Americans are able to receive testing and treatment for COVID-19. According to the U.S. Department of Health & Human Services, at least $175 BILLION was targeted for hospitals and healthcare providers on the front lines of the coronavirus response.
Per the U.S. Department of Health & Human Services, the Provider Relief Fund payments are paid to certain Medicare fee-for-service healthcare providers, and Medicaid, Children’s Health Insurance Program (CHIP), and dental providers who offer diagnoses, testing, or care for individuals with possible or actual cases of COVID-19.
Qualified health care providers may receive Provider Relief Fund payments for healthcare-related expenses or lost revenue due to COVID-19, as stated by the U.S. Department of Health & Human Services. Separately, the COVID-19 Uninsured Program reimburses providers for testing and treating uninsured individuals with COVID-19.
Providers must make certain promises or certifications to use the money for lawful purposes. Provider Relief funds are subject to certain terms and do not need to be repaid to the Government if the healthcare provider meets certain conditions. The U.S. Department of Health & Human Services also calls this “loan forgiveness.”
The Department of Justice has said that it anticipates there will be wrongful spending of money under the CARES Act Provider Relief Program administered by the United States Department of Health and Human Services (HHS).
If you are aware of any of the following COVID-19 fraud schemes, for example, the Department of Justice may be interested in speaking with you:
- Providers taking money without meeting eligibility requirements
- Providers using the money for anything other than preventing, preparing for, and responding to the coronavirus pandemic
- Providers using the money for medically unnecessary services or unreasonable services
- Providers using the money for worthless services, meaning services that were substandard, dangerous, or which caused or could have caused harm or death to patients
- Providers using the money for expenses or lost revenues that are not attributable to coronavirus
- Providers using the money to pay for services for which they were already reimbursed
- Providers using the money to offer illegal inducements to others to use their services, meaning the money was used to pay kickbacks
Many health care organizations, manufacturers, and suppliers received government contracts, including:
- Manufacturers of medical and surgical devices and instruments
- Biotechnology companies performing research and development
- Wholesalers and distributers of medical, hospital, and dental equipment and supplies
- Computer and technology-related companies
The U.S. Department of Health and Human Services is contracting with healthcare companies to provide these services:
- $17 BILLION to procure personal protective equipment (PPE), ventilators and other medical supplies to stockpile
- $4.3 BILLION for preparedness and response, surveillance, and diagnostics
- $3.5 BILLION to manufacture and produce vaccines, therapeutics, and diagnostics
- $1.78 BILLION for vaccine, therapeutic, and diagnostic research
- $80 MILLION to support the development and manufacturing of countermeasures and vaccines, as well as the monitoring of supply chains
Any potential fraud involving these COVID-related government contracts by contractors, subcontractors, or any other participants in these contracts would be of interest to the Department of Justice.
Here are some of the traditional fraud schemes the Department of Justice has seen involving government contracting:
- Falsifying information on contract proposals
- Using money under contracts to buy items that are not allowable under the contract or are not used for government purposes
- Double-billing under contracts
- Billing for expenses not allowable under the contract
- Billing for work that was never performed
- Falsifying data
- Making substitutions of materials or equipment that is not allowable under the contract
- Misrepresenting the status of a project while continuing to receive government funds under the contract
- Charging higher rates than allowable under the contract
The Department of Justice is also interested to hear about any allegations that government employees or contracting officers were influenced to grant a contract to a particular company or a family member or allegations of bribery, kickbacks, gratuities, and conflicts of interest.
The U.S. Department of Veterans Affairs is contracting with these health care companies or for these healthcare-related services:
- $14.4 BILLION to support increased demand for healthcare services and additional support for veterans
- $2.15 BILLION to support increased telework, telehealth, and call center capabilities
- $2.1 BILLION to support increased demand for care
- $606 MILLION to support the development of alternative sites of care
- $150 MILLION to support modification of alterations of existing facilities
- $100 MILLION to support 24-hour emergency management coordination
- $13 MILLION to provide additional software licenses and telework support
- $12.5 MILLION for oversight
- $6 MILLION to expand and maintain 24-hour operations of Crisis Response and Continuity of Operations Plan
If you are aware of old, new, or evolving fraud schemes involving government funding related to the coronavirus, COVID-19, or the CARES Act, the Department of Justice may be very interested in learning more about the information you have. You may also be entitled to a financial reward. Tell us about the information you have. We will provide you a free consultation.
