Medical Equipment Company CEO Sentenced for Medicare Fraud in “Operation Brace Yourself” Scheme
The chief executive officer (CEO) of several Georgia durable medical equipment companies is the first defendant to be sentenced in an ongoing federal investigation of a nationwide scheme called “Operation Brace Yourself.” The multi-year scheme is estimated to have billed Medicare for about $10 million.
The CEO worked with a number of others to operate a network involving the payment of illegal kickbacks and bribes to medical professionals in exchange for referrals of Medicare beneficiaries. Those medical professionals operated fraudulent telemedicine companies that provided medically unnecessary braces for the back, shoulder, wrist, and knees. Some of the defendants involved in the scheme controlled an international telemarketing network that lured thousands of elderly and/or disabled patients in the criminal scheme.
The network had call centers based in the Philippines and throughout Latin America and paid doctors to prescribe medical equipment both with and without patient interaction. Any contact with patients involved only a brief telephone conversation by doctors who had never met or seen them.
The CEO was sentenced to serve more than three years in prison and pay more than $1.9 million in fines and restitution.
Compliance Perspective
Failing to ensure that vendors providing durable medical equipment to residents have been thoroughly investigated (not on OIG exclusion list), and have properly completed contracts on file, may affect the facility’s eligibility to receive Medicare and Medicaid reimbursements if the vendor violates the federal False Claims Act and Anti-kickback Statute.
Discussion Points:
- Review policies and procedures regarding vendor contracts.
- Train staff involved in the contract process regarding the investigation and screening protocols and the documents and information to be provided by the vendor.
- Periodically conduct an audit to ensure that vendors providing services to the facility have not been excluded or sanctioned due to Medicare and Medicaid related program violations and are not on the OIG list of excluded individuals and entities or disqualified contractors.
