In September, a Florida nurse practitioner (“NP”) was convicted of health care fraud for her role in an arrangement that billed Medicare approximately $200 million dollars for expensive genetic testing and orthotic braces that the Medicare beneficiaries did not need and were ordered as a result of telemedicine visits that she often never performed. Last week, the NP was sentenced to 20 years in prison for her part in this scheme.
Per court documents, to generate patients, telemarketing companies contacted Medicare beneficiaries to convince them to request orthotic braces and genetic tests. The telemarketing company then sent pre-filled orders for the products to the NP. The NP subsequently ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the nation, including oncologists and geneticists who would be actively utilizing the results of such tests. Moreover, thousands of these orders were issued for patients she had never spoken to, examined, or treated. In some instances, she did not even authorize the order, but instead had others (including non-licensees) sign her name to fraudulent orders.
The NP fraudulently billed Medicare for conducting complex office visits with patients for whom she issued orders, and routinely billed more than 24 hours of “office visits” in a single day, which many insurers flag as an “impossible day.” For her efforts, she personally benefited by obtaining approximately $1.6 million in the scheme. Several of the NP’s co-conspirators in the fraudulent arrangement testified at the NP’s trial and are either awaiting sentencing or have already received prison sentences ranging from two to eleven years in prison.
While telehealth practitioners have been subject to significant enforcement actions in the past, many government investigations have focused on using clinicians’ testimony to build cases against the architects and administrators of the larger scheme, rather than pursuing significant penalties against each individual practitioner as the focal point of the government’s enforcement. The NP’s 20-year prison sentence not only demonstrates that the government will continue to actively pursue practitioners, but also how the government is committed to centering its enforcement actions against a practitioner who is viewed as having sold their credentials to unscrupulous business partners as a “stamp for hire” to generate fraudulent orders. In such a scheme, even though the NP may not have received the greatest financial benefit as compared to other co-conspirators, none of the orders would have been issued without her willingness to fraudulently use her credentials.
How Frier Levitt Can Help
Substantial enforcement of fraudulent telehealth models emphasizes the government’s focus on this area. Stakeholders must remain cognizant of state and payor requirements for telehealth encounters, including those conditions necessary to establish a bona fide practitioner-patient relationship sufficient to issue a medically necessary order for a test, drug, or device. Compliance in a telehealth model requires an analysis of an amalgam of federal and state laws, as well as payor guidelines for billing. Providers are encouraged to seek the advice of competent healthcare counsel to ensure their compliance and understand the liabilities associated with orders that could be perceived as medically unnecessary.
Frier Levitt attorneys have advised management organizations, practitioners, other ancillary providers, marketers, and technology companies on developing and restructuring telehealth business models to comply with applicable federal and state law while considering obstacles such as licensing, prescribing, and insurance reimbursement concerns unique to each arrangement. Our attorneys also represent clients in connection with criminal investigations and prosecutions and civil and administrative actions involving allegations of unlawful prescribing, issuance or receipt of payments, and/or filling of prescriptions and orders associated with all health models. Contact Frier Levitt to consult with an experienced telehealth attorney.
