On April 9, 2024, the Justice Department’s COVID-19 Fraud Enforcement Task Force (CFETF) released its 2024 report which outlines the actions taken by the task force and its member agencies in response to widespread fraud related to various COVID-19 relief programs. The CFETF was established by the Attorney General in May 2021 to marshal the resources of the Justice Department in partnership with agencies across the US government to enhance efforts to combat and prevent pandemic-related fraud.
According to the press release, to date, the efforts of the task force’s member agencies has led to criminal charges against more than 3,500 defendants for losses of over $2 billion, civil enforcement actions resulting in more than 400 civil settlements and judgments of over $100 million, and over $1.4 billion seized or forfeited.
Some examples in the report include:
- A former VA nurse was sentenced to 18 years in prison for conspiring to fraudulently obtain more than $3.5 million in unemployment insurance (UI) benefits from at least five states. She and her co-conspirators filed more than 220 false applications for unemployment insurance benefits using stolen identities and the identities of state and federal prison inmates.
- A defendant was sentenced to eight years and six months in prison for obtaining more than $7.2 million in Paycheck Protection Program (PPP) loan funds, which he used to purchase Maserati and Mercedes-Benz cars and buy a 12-acre estate.
- A Georgia urgent care chain agreed to pay $1,600,000 to resolve allegations that they violated the False Claims Act (FCA) by submitting improperly upcoded Evaluation and Management claims to Medicare for the testing and treatment of patients with suspected exposure to COVID-19 during the Coronavirus pandemic.
- A defendant pleaded guilty to submitting more than $17.9 million in fraudulent CARES Act loan applications on behalf of himself and his coconspirators, using the illicitly obtained funds to travel internationally, purchase property in Egypt, and open a beachfront restaurant.
You can access the report here.
Compliance Perspective
Issue
Misuse of allocated public funds can be seen as fraud, waste, and abuse of government funds. The Centers for Medicare & Medicaid Services (CMS) requires skilled nursing facilities to have a compliance and ethics program that is effective in preventing and detecting criminal, civil, and administrative violations under the Social Security Act, and in promoting quality of care. Routine audits should be conducted at each facility on monetary transactions and the results of the audits should be reported to the compliance and ethics committee and to the governing body. The audits should have a corrective action plan to address any identified discrepancy, and all discrepancies should be investigated and rectified immediately.
Discussion Points
- Review your policies and procedures for operating an effective compliance and ethics program. Ensure that your policies are reviewed at least annually and updated when new information becomes available.
- Train all staff on your compliance and ethics policies and procedures upon hire and at least annually, including their responsibility to identify and report any concerns of fraud, waste, or abuse of government funds in a timely manner. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically perform audits to ensure all staff are aware of the importance of identifying compliance and ethics concerns and their responsibility to report them to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, LLC for informational purposes only and is not intended to provide legal advice.*
