DME Fraud Enforcement: Telemarketing & Telemedicine

by admin on August 12, 2019 No comments

By: Michael Silverman

The indictments and regulatory activities that took place on April 9th were just the tip of the iceberg when it comes to the crackdown on DME fraud, telemarketing and telemedicine operations.

In the weeks and months that have followed ‘Operation Brace Yourself’, healthcare providers (such as DME suppliers and telehealth physicians) and telemarketers allegedly involved in these activities have been subjected to a wide range of penalties from suspension of Medicare billing privileges to civil penalties and/or criminal charges. Here are some of the more serious recent DME, telemarketing and telemedicine related civil and criminal regulatory enforcement actions:

On Thursday August 1st the Department of Justice announced that an individual and several related businesses agreed to resolve allegations of civil False Claims Act violations through a pre-trial settlement for $2,500,000.00. The government alleged that the defendants were involved in an illicit telemedicine and telemarketing scheme in violation of the federal anti-kickback statute and false claims act, whereby telemedicine physicians wrote medically unnecessary prescriptions that were then sold to healthcare providers. This action involved pharmacy items such as pain creams, and which predated and was unrelated to Operation Brace Yourself. There was a separate related criminal action.

On July 9th an anesthesiologist was indicted, charged with conspiracy to commit healthcare fraud. It is alleged that she was inappropriately writing DME and pharmacy prescriptions under the guise of a proper telemedicine evaluation in exchange for a kickbacks.

The first ‘Operation Brace Yourself’ related sentencing: On May 3 the owner of several DME companies whose involvement with inappropriate telemedicine and telemarketers resulted in almost $10MM in billings was sentenced to serve 40 months in prison and repay almost $2MM.

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