A federal jury convicted a Louisiana nurse practitioner on May 2, 2025, for her role in a healthcare fraud scheme involving over $2 million in false claims to Medicare.
According to court documents and evidence presented at trial, the defendant, 45, of Opelousas, was a nurse practitioner and enrolled provider with Medicare. She worked as an independent contractor for companies that purportedly provided telehealth services to Medicare beneficiaries. As part of the scheme, she caused the submission of false claims for medically unnecessary durable medical equipment (DME), including knee braces and suspension sleeves, for patients she or other providers had not examined.
She concealed the fraud by signing documents falsely certifying that she had consulted with the beneficiaries and conducted personal assessments. Between 2017 and 2019, she signed more than 1,000 DME orders, resulting in over $2 million in fraudulent claims and more than $1 million in Medicare reimbursements. In return, she received kickbacks and bribes from the telehealth companies.
The US Department of Health and Human Services Office of Inspector General (HHS-OIG) investigated the case. The defendant was convicted of five counts of healthcare fraud. She is scheduled to be sentenced on July 31 and faces a maximum penalty of 10 years in prison on each count.
“This defendant not only defrauded the Medicare program but went against everything the medical profession stands for, which is a promise to provide ethical and responsible patient care,” said US Attorney Alexander C. Van Hook for the Western District of Louisiana. “She took advantage of beneficiaries who were elderly and handicapped to order items for them that were not medically necessary. This office is committed to continuing to work with our federal partners to stop this type of fraud in the Western District of Louisiana.”
Compliance Perspective
Issue
The OIG has conducted numerous investigations into fraud schemes involving companies and individuals that falsely claimed to provide telehealth, telemedicine, or telemarketing services, exploiting the use of telehealth. These schemes raise significant concerns due to their potential to cause considerable harm to federal healthcare programs and their beneficiaries. Practitioner arrangements with telemedicine companies may also lead to criminal, civil, or administrative liability under federal laws including, for example, the federal anti-kickback statute, OIG’s exclusion authority related to kickbacks, the Civil Monetary Penalties Law provision for kickbacks, the criminal healthcare fraud statute, and the False Claims Act.
Discussion Points
- Review facility policies on telemedicine to ensure they effectively safeguard against fraud, waste, and abuse. Make sure they emphasize compliance with legal requirements and that identifying and reporting fraudulent claims or kickbacks is integrated into the compliance program.
- Provide education to nursing and business office staff about their responsibility to identify and report concerns regarding unnecessary medications, treatments, supplies, or equipment. Ensure that training on fraud, waste, and abuse includes the prohibition of accepting illegal kickbacks or bribes for ordering medical equipment, lab tests, or prescriptions. Staff should be aware of their obligation to report suspicious activities to supervisors or via the facility’s hotline.
- Conduct routine audits to verify the appropriate use of telemedicine services and ensure staff are not involved in bribery or kickbacks. Regularly assess staff awareness of their responsibility to report compliance issues and ensure they know how to report concerns to supervisors, the compliance officer, or anonymously via the hotline.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*