A Michigan doctor was sentenced on June 26 to four years in prison for a $6.3 million Medicare fraud scheme involving the distribution of orthotic braces to elderly and disabled patients who did not need them. She was also ordered to pay $3,606,935 in restitution and $120,475 in forfeiture.
According to court documents and evidence presented at trial, the doctor, 56, of Bloomfield Hills, prescribed more than 7,900 orthotic braces to over 2,600 Medicare beneficiaries during a six-month period. The patients were recruited through television advertisements offering free back braces. When patients called the advertised number, they were persuaded to accept braces for additional parts of the body, with assurances that Medicare would cover the cost.
The doctor spoke briefly by phone with some of the patients and had no contact at all with others. Despite this, she signed orders for more than 7,900 braces, including prescribing four or more braces to nearly 1,000 patients. She prescribed up to 136 braces in a single day, 12 braces to one patient, and issued prescriptions for undercover agents posing as Medicare beneficiaries after telephone conversations lasting less than one minute.
The prescriptions and associated medical records signed by the doctor falsely indicated that the braces were medically necessary. The records also falsely stated that she had diagnosed the patients, developed care plans, and recommended additional treatment. In one case, she prescribed five braces for a patient for whom Medicare was billed $3,883. She falsely attested that she had evaluated the patient and that the patient was mobile, when the patient had long been confined to a wheelchair and was suffering from a spinal infection requiring surgery, not braces.
The false prescriptions were used by brace supply companies to bill Medicare for more than $6.3 million. The doctor received approximately $120,000 from companies purporting to provide telemedicine services in exchange for signing the fraudulent orders.
The FBI and the Department of Health and Human Services Office of Inspector General (HHS-OIG) investigated the case. It was prosecuted as part of Operation Rubber Stamp, a coordinated national law enforcement initiative targeting medical professionals involved in fraudulent telemedicine schemes.
Compliance Perspective
Issue
The Office of Inspector General (OIG) has conducted numerous investigations into fraud schemes involving individuals and entities that claim to provide telehealth, telemedicine, or telemarketing services. These schemes have exploited the growing use of telemedicine and raise concerns due to the potential for significant harm to federal healthcare programs and their beneficiaries. Risks include: (1) increased costs to federal programs for medically unnecessary items and services, including those never received by beneficiaries; (2) harm to beneficiaries through unnecessary care, inappropriate items, or delays in needed treatment; and (3) corruption of medical decision-making. Practitioner arrangements with telemedicine companies may also result in criminal, civil, or administrative liability under federal laws, such as the Anti-Kickback Statute, the OIG’s exclusion authority, the Civil Monetary Penalties Law, the healthcare fraud statute, and the False Claims Act.
Discussion Points
- Review policies and procedures governing the use of telemedicine services and the prevention of fraud, waste, and abuse. Confirm that your compliance and ethics program includes guidance on identifying and reporting false claims, kickbacks, and other potentially improper practices.
- Educate nursing, clinical, and business office staff on how to identify and report concerns related to unnecessary medications, treatments, equipment, or services. Provide training on fraud, waste, and abuse prevention, and clarify that offering or accepting kickbacks in exchange for ordering supplies, tests, or medications is prohibited. Reinforce that staff should report concerns to a supervisor or through the facility’s hotline.
- Conduct routine audits to monitor the use of telemedicine tools and ensure that staff are not participating in or facilitating improper arrangements. Include assessments of staff awareness regarding their obligation to report compliance and ethics concerns to their supervisor, the compliance and ethics officer, or via the anonymous hotline.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*