Enforcement of DME Telehealth Fraud Schemes Continues Full Force

According to the DOJ’s indictment, Ms. Lavache prescribed DME for Medicare beneficiaries without conducting any consultations with the said beneficiaries. As a result, she allegedly caused the submission of false claims to Medicare totaling approximately $8.8 million.  In exchange for issuing the DME prescriptions, Ms. Lavache allegedly received approximately $123,000 in kickbacks, a minuscule amount compared to the millions of dollars that were billed to and paid by Medicare. Nonetheless, Ms. Lavache is now facing up to 60 years in prison if convicted on all counts (one count of conspiracy to commit health care fraud and wire fraud, and four counts of health care fraud).

Similarly, in May 2022, Ankita Singh, an Ohio physician was also charged with healthcare fraud for her alleged role in fraudulently billing $8.4 million to Medicare. According to Dr. Singh’s indictment, she received order forms for durable medical equipment, prosthetics/orthotics and supplies (DMEPOS) from telemarketers and signed them without ever speaking to, examining, assessing, and/or otherwise establishing a doctor-patient relationship with any of the beneficiaries. In exchange, she was paid approximately $15-$20 per form and is now facing a prison sentence, if convicted, despite having minimum involvement in the alleged fraud scheme and receiving a de minimis financial benefit from same.

These types of DME enforcement actions are not new. In fact, on April 9, 2019, the DOJ initiated “Operation Brace Yourself,” a Telemedicine and Durable Medical Equipment Takedown, in an effort to combat DME fraud. The Operation targeted ongoing schemes in which companies were paying kickbacks to secure signed physicians’ DME orders for use as support for fraudulent claims submitted to federal healthcare programs. The DOJ estimated that Operation Brace Yourself alone resulted in a cost avoidance of more than $1.9 billion in the amount paid by Medicare for orthotic braces in the 20 months following the takedown. Following successful operations such as Operation Brace Yourself, DME fraud enforcement continues and shows no signs of slowing down in the near future.

Indeed, as evident by the latest indictments, the DOJ is focusing its efforts on all parties involved in the DME fraud schemes, including those receiving comparatively minor financial gain to prescribe DME and those having no involvement in billing DME to federal payors, such as Medicare, Medicaid, and/or TRICARE.

DME Suppliers, Prescribers, and Pharmacies

If you or your business is involved in any aspect of DME prescribing, and/or fulfillment of DME orders, it is of the utmost importance that your business practices are compliant. A thorough review of contractual agreements, particularly those involving telehealth companies and marketing contracts, is especially prudent at this junction to ensure that the DME orders are being issued and fulfilled compliantly. Additionally, if you and/or your healthcare business contracted with any telehealth and/or marketing companies, especially those listed below, you should contact a healthcare defense attorney without delay.

  • Comprehensive Telcare, LLC;
  • REMN Management LLC;
  • Telehealth Doctor’s Network, LLC (dba “Video Doctor USA”); and
  • Telemed Health Group, LLC (dba “AffordADoc”);

These companies, and many others, are currently under investigation for their DME prescribing practices and/or already facing charges for their involvement in various healthcare fraud schemes. As such, if you conducted business with any of these or similar companies, it is highly likely that the DOJ will be reviewing your DME orders with a particular focus on potential fraud schemes. Notably, the DOJ’s inquiries, while they may start out as limited on their face, have the propensity to uncover areas of liability outside of the original subject matter as the investigation progresses.

How Frier Levitt Can Help

Healthcare providers who are authorized to prescribe and/or fulfill DME orders must be aware of state and federal laws and regulations on appropriate practices. Frier Levitt has extensive experience representing physicians and healthcare providers in a variety of matters, including advising on compliant prescribing practices, as well as with representation in criminal investigations and prosecutions and civil and administrative actions involving allegations of unlawful prescribing and/or filling of prescriptions and orders. Contact us for a complimentary consultation for more information regarding these or any other healthcare topics.