A Florida man is one of 26 charged in telemedicine-kickback fraud in the U.S. Southern District alleged to be in the millions of dollars. The man was the owner of a durable medical equipment company, and he pleaded guilty to one count of conspiracy. He also admitted to paying kickbacks in return for “leads” which were signed orders from physicians and nurse practitioners. The beneficiaries, whose identities were used to bill Medicare, were located in the Southern District of Georgia and throughout the country.
The charge carries a sentence of up to five years in prison plus substantial financial penalties and forfeitures, followed by three years of supervised release upon completion of any prison sentence. There is no parole in the federal system.
This prosecution, arising out of the related “Operation Brace Yourself” and “Operation Double Helix,” together with 25 other cases, involves the largest fraud operation in the history of the Southern District of Georgia. Those charged in this string of cases include eight physicians, two nurse practitioners, three operators of different telemedicine companies, three brokers of patient data, and several other owners of durable medical equipment companies.
The combined $480 million in fraud charged in the Southern District of Georgia is part of nationwide operations by the Department of Justice that thus far have included allegations involving billions of fraudulent claims for genetic testing, orthotic braces, pain creams, and other items.
Compliance Perspective
Failure bylong-term healthcare providers to be vigilant in their efforts to protect residents identities and ensure that physicians, nurse practitioners, and vendors, e.g., durable medical equipment providers, are screened for possible exclusion from Medicare and Medicaid and that no one associated with the facility is accepting kickbacks for furnishing the identities of beneficiaries may result in violations of state and federal regulations, including the Anti-Kickback Statute and the Stark Law. This is particularly problematic during the COVID-19 pandemic where increased use of telehealth/telemedicine technology is allowed by the Centers for Medicare & Medicaid Services (CMS), thus increasing the potential number of fraudulent schemes involving submission of false claims.
Discussion Points:
- Review policies and procedures regarding the use of telehealth/telemedicine technology and the process for conducting due diligence to ensure that any healthcare provider or vendor associated with the facility is not excluded from government healthcare programs by the Office of Inspector General (OIG) and that protocols are in place to safeguard residents’ identities and protected health information (PHI).
- Train staff involved in the use of telehealth/telemedicine technology within the facility to be aware of potentially fraudulent schemes to gain access to Medicare/Medicaid beneficiaries’ identities.
- Periodically audit to ensure that all employees, healthcare providers, and vendors have been screened for potential exclusion by the OIG. Share information with residents and family members about fraudulent schemes they may encounter, particularly involving durable medical equipment.
FRAUD MODULE 3 – MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
STAYING ON TOP OF EMPLOYEE CHECKS
