A Florida man who supplied Medicare patient information to his co-conspirators to support their durable medical equipment claims is the 26th defendant charged in a telemedicine conspiracy being prosecuted in the U.S. Southern District of Georgia.
According to court filings, the defendant received a percentage of the profit from a durable medical equipment company that billed Medicare for the equipment in exchange for supplying Medicare patients’ identifications and insurance information. The financial total for orders facilitated through this scheme is alleged to be more than $6 million.
This prosecution, arising out of the related “Operation Brace Yourself” and “Operation Double Helix,” together with those previously announced, continues to add to the largest fraud operation prosecuted in the history of the Southern District of Georgia. Those previously charged in this string of cases include eight physicians, two nurse practitioners, three operators of different telemedicine companies, two other brokers of patient data, and several owners of durable medical equipment companies. The Medicare and Medicaid beneficiaries whose identities were used as part of the scheme are located throughout the country, including in the Southern District of Georgia.
The combined total of more than $480 million in fraud charged in the Southern District of Georgia is part of nationwide operations by the Department of Justice that thus far has included allegations involving billions of dollars in fraudulent claims for genetic testing, orthotic braces, pain creams, and other items.
Compliance Perspective
Issue
Failure to have a properly executed agreement when doing business with an outside provider of durable medical equipment that engages in fraudulent billing may cause the facility to be excluded from participating in the Medicare/Medicaid Programs. The facility must ensure that services provided are as expected and compliant with state and federal regulations intended to prevent kickbacks and use of residents’ personal information in the submission of false claims for unnecessary equipment or items not provided.
Discussion Points
- Review policies and procedures for using outside vendors and the screening process for ensuring they have not been excluded from Medicare or Medicaid.
- Train staff who secure outside resources from vendors to follow procedures for completing background checks and obtaining properly executed agreements prior to using their services.
- Periodically audit to ensure that all outside resource providers/vendors are screened before services begin, and that they sign agreements to comply with state and federal laws prohibiting kickbacks and the submission of false claims.
FOR MORE INFORMATION ON THIS TOPIC view: FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS and FRAUD MODULE 10 – VENDOR CONTRACTS
