A federal jury convicted a Texas doctor on May 24, 2024, for causing the submission of over $70 million in fraudulent claims to Medicare for medically unnecessary orthotic braces and genetic tests ordered through a telemarketing scheme.
According to court documents and evidence presented at trial, the doctor signed thousands of medical records and prescriptions for orthotic braces and genetic tests that falsely represented that the braces and tests were medically necessary and that he had diagnosed the beneficiaries, had a plan of care for them, and recommended that they receive certain additional treatment. He prescribed braces and genetic tests for over 13,000 Medicare beneficiaries, including undercover agents posing as different Medicare beneficiaries, many of whom he did not see, speak to, or otherwise treat.
The doctor’s false prescriptions were then used by brace supply companies and laboratories to bill Medicare more than $70 million. The doctor was paid approximately $475,000 in exchange for signing the fraudulent prescriptions.
The jury convicted the doctor of one count of conspiracy to commit healthcare fraud, which carries a maximum penalty of 10 years in prison, and three counts of false statements relating to healthcare matters, each of which carries a maximum penalty of five years in prison. He is scheduled to be sentenced at a later date.
Compliance Perspective
Issue
In recent years, the Office of Inspector General (OIG) has conducted numerous investigations into fraud schemes involving companies and individuals claiming to provide telehealth, telemedicine, or telemarketing services. These schemes exploit the growing acceptance and use of telehealth, and raise concerns about potential harm to federal healthcare programs and their beneficiaries. Risks include: (1) increased costs to federal healthcare programs due to medically unnecessary items and services, sometimes even when beneficiaries never receive them; (2) potential harm to beneficiaries through unnecessary care or items that could be detrimental to patients; and (3) corruption of medical decision-making. Additionally, practitioner arrangements with telemedicine companies may result in criminal, civil, or administrative liability under federal laws, including the anti-kickback statute, OIG’s exclusion authority, the Civil Monetary Penalties Law, the criminal healthcare fraud statute, and the False Claims Act.
Discussion Points
- Review policies and procedures regarding the use of telemedicine within the facility and preventing fraud, waste, and abuse. Also review your policies and procedures for operating an effective compliance and ethics program to ensure that the identifying and reporting of false claims or kickbacks is part of your policy.
- Provide education to nursing and business office personnel on their responsibility to identify and report any concerns that unnecessary medications, treatments, supplies, or equipment are being ordered for residents. Train staff about fraud, waste, and abuse and the prohibition regarding acceptance of illegal kickbacks and bribes in exchange for ordering medical equipment, performing lab tests, prescribing medications, and other activities. Staff who observe or reasonably suspect that kickbacks and bribes are being offered or accepted should report such suspicions to their supervisor or through the facility’s Hotline.
- Periodically audit to determine if telemedicine tools are being used appropriately and that facility personnel are not being offered or accepting bribes or kickbacks. Also audit to ensure that staff are aware of their responsibility to identify compliance and ethics concerns and to promptly report violations 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.*
