Orthopedic Surgeon Indicted in Alleged Telemedicine Scheme
Last week, the United States Department of Justice (“DOJ”) announced that an orthopedic surgeon had been indicted by a federal grand jury due to his alleged involvement in a $10 million fraudulent healthcare scheme. According to the DOJ, the surgeon was engaged in the practice of telemedicine as part of the AffordADoc Network. Of note, and as discussed in a previous article, AffordADoc’s owner and CEO pled guilty and agreed to pay $200 million in fines because of illegal kickbacks paid to physicians.
Allegedly, between July 2016 and June 2017, the surgeon participated in a scheme in which he signed prescriptions and order forms for durable medical equipment (“DME”) that were not medically necessary and were subsequently paid for by Medicare. The indictment asserts that the surgeon never conducted physical examinations of these patients, and, instead, ordered DME based only on a short telephone conversation with Medicare beneficiaries. The DOJ contends that these orders were based, in part, on the payment of improper bribes or kickbacks. For example, the surgeon allegedly received $25 or $30 per telephone consultation. As a result of the fraudulent scheme, this individual surgeon caused to be submitted approximately $10 million in fraudulent claims, He now faces up to ten (10) years in prison.
The DOJ continues to reiterate its focus on identifying an uprooting health care fraud schemes related to telehealth and telemedicine. Telemedicine arrangements must be structured appropriately to avoid improper kickbacks and comply with applicable federal and state laws. Furthermore, telemedicine providers must ensure that a bona fide provider-patient relationship is established prior to billing for the encounter or ordering and ancillary service. Contact Frier Levitt for guidance and review of your current or proposed telehealth business model.