The Perfect Enemy | DOJ target 18 providers in massive wrongful billing, PPP fraud sweep - Modern Healthcare
February 19, 2024

DOJ target 18 providers in massive wrongful billing, PPP fraud sweep – Modern Healthcare

DOJ target 18 providers in massive wrongful billing, PPP fraud sweep  Modern HealthcareView Full Coverage on Google News

Dr. Anthony Hao Dinh allegedly bilked the federal government out of $150 million and lost most of it placing high-risk bets in the stock market.

Dinh, an ear, nose and throat specialist who practices in Orange County, California, allegedly accumulated the $150 million after submitting $230 million in fraudulent claims to the Health Resources and Services Administration COVID-19 Uninsured Program, according to the Justice Department.

Dinh was the second-highest biller in the federal program intended to provide care for uninsured consumers during the pandemic, according to federal authorities. He also faces charges for allegedly obtaining more than $3 million in loans after submitting more 70 fraudulent applications under the Paycheck Protection Program and Economic Injury Disaster Loan Program.

Dinh did not respond to requests for comment. If convicted, he could serve up to 50 years in federal prison.

According to the lawsuit filed by the federal government in the Central District Court of California April 10, Dinh allegedly transferred the proceeds to bank accounts held by shell companies he owned and moved them to personal bank accounts. He engaged in high-risk options trading and subsequently lost more than $100 million from November 2020 through February 2022, the complaint alleges.

Law enforcement interviewed 40 of Dinh’s patients, most of whom were covered by insurance and said they did not receive the medical services, including surgeries, that Dinh charged to HRSA’s uninsured program.

One patient, who was a soldier for the National Guard, took about 60 soldiers to an Elite Care clinic in Newport Beach, California, where Dinh worked to receive free COVID-19 tests. They “thought it was weird that no one asked the soldiers, who were dressed in uniform, whether they carried insurance,” the suit alleges. That patient took COVID-19 tests but told investigators he did not receive any of the services billed to the uninsured program, including a biopsy with an endoscope and complex control of a nosebleed, the complaint alleges.

Elite Care is not named as a defendant in the case.

Dinh is part of the federal government’s latest COVID-19 fraud roundup, levying criminal charges against 18 defendants who allegedly illegally billed federally funded pandemic programs $490 million. Some are new cases and some are superseding indictments. Officials filed similar COVID-19 fraud charges in April 2022 and May 2021

“Today’s announcement marks the largest-ever coordinated law enforcement action in the United States targeting healthcare fraud schemes that exploit the COVID-19 pandemic,” Assistant Attorney General Kenneth A. Polite, Jr. said in a news release.

Investigators also filed charges against a lab operator in Southern California. Lourdes Navarro, who helped managed clinical labs in the Glendale, California, area, allegedly added claims for respiratory pathogen tests for nursing home residents even though they were not requested or needed, according to a superseding indictment filed April 13 in the Central District Court of California.

Navarro, who was previously indicted in April 2022, faces additional allegations involving $358 million in fraudulent claims billed to Medicare, HRSA’s COVID-19 Uninsured Program and an unnamed insurance company that allegedly took kickbacks and bribes.

Navarro did not respond to requests for comment. 

Prosecutors also have filed cases against providers in Florida, Louisiana, New York, Utah and Puerto Rico. Charges range from allegedly billing the program for providing COVID-19 tests to consumers who were already deceased to creating fake vaccination cards.