Wisconsin Physician Sentenced to 54 Months for DME Telehealth Scheme to Defraud Medicare

On November 22, 2021,  the U.S. Attorney’s Office for the Western District of Wisconsin announced that Dr. Ravi Murali, a Wisconsin physician, was sentenced to 54 months in prison as part of his role in a scheme to defraud Medicare.

According to the announcement and a previous press release concerning his indictment, the physician wrote thousands of fraudulent orders for durable medical equipment (“DME”) despite not having established a prescriber-patient relationship or otherwise conducting appropriate testing and evaluation of the Medicare beneficiaries. The orders were written between January 2017 and January 2020, while the physician was employed by various telemedicine companies.

According to the announcements, other participants in the scheme used the fraudulent orders submitted by Dr. Murali to bill Medicare $26 million, of which $13 million was paid. Of note, Dr. Murali’s grand jury indictment lists several of the allegedly fraudulent DME orders, for which Medicare paid about $500-700 per order. Dr. Murali, in contrast, was compensated $30 per “consultation.”

Key Takeaways

Physicians and other prescribers play a key role in telehealth models because they serve as gatekeepers who are empowered to appropriately prescribe drugs and order labs or devices for their patients. Considering this critical role, prescribers have faced significant exposure in recent telehealth-related enforcement actions, even where they do not otherwise serve as the founders or organizers of the alleged telehealth scheme. It is not uncommon for prescribers involved in Medicare-related telehealth fraud schemes to face penalties that include months, if not years, of imprisonment.

How Frier Levitt Can Help

As Frier Levitt has recently described, fighting alleged telehealth fraud remains a priority for the Department of Justice. Federal prosecutors have successfully targeted numerous individuals and entities involved in non-compliant telehealth or telemedicine models, particularly where marketing activities drove patient utilization of the telehealth or telemedicine services.

Every participant in a telehealth model can be exposed to liability if other stakeholders in the arrangement do not compliantly structure their business dealings. As such, all participants — including marketers, prescribers, pharmacies, and suppliers — must conduct reasonable due diligence as to the entirety of the telehealth model in which they intend to participate.

Frier Levitt’s team of healthcare attorneys has extensive experience advising clients in developing telehealth and marketing models, in addition to bringing such arrangements into compliance with applicable law. If you, your medical practice, or your pharmacy or laboratory are involved in rendering care to patients via telehealth or receiving telehealth-generated prescriptions or orders, contact Frier Levitt to discuss and review the compliance of your business arrangements

 

 

 

 

 

 

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