On April 9. 2019,, the Department of Justice announced healthcare fraud arrests of 24 individuals, including doctors and executives at telemedicine and durable medical equipment (DME) companies. Theses arrests are the result of federal charges relating to alleged bribes and illegal kickbacks.
The government’s allegations describe a federal healthcare fraud scheme within which doctors at telemedicine companies received bribes and illegal payments, often called kickbacks, from companies marketing DME.
In exchange for those payments, the doctors allegedly prescribed and recommended DME, such as back and knee braces, to patients who didn’t have a legitimate medical need for them. There was also a telemarketing company that allegedly connected some of these telemedicine companies to DME suppliers.
The government alleges that the doctors at these telemedicine companies, who generally interact with patients through audio-visual communications rather than in-person visits, recommended DME to patients and referred them to the DME companies that paid them, sometimes without actually examining the patients. Federal healthcare programs like Medicare and Medicaid would then reimburse the DME companies for the equipment, which the government contends led to over $1.2 billion in losses.
Of course, not every telemedicine company is fraudulent, and the companies targeted here aren’t fraudulent just because the government says so. In fact, many telemedicine companies provide a necessary service by using telecommunications technology to provide healthcare treatment to patients in rural areas or who otherwise lack access to adequate healthcare.
Our firm has successfully represented dozens of doctors and other professionals in federal healthcare fraud cases. In our experience, the government often over-charges people in these cases to “send a message” that they are cracking down on healthcare fraud. The press releases and news conferences give the appearance that such fraud is rampant and that the people charged in this case are necessarily guilty. But that’s just not so.
The truth is that many of the patients who were prescribed DME that was later paid for by Medicare may have legitimately needed it, or the doctor may have had a legitimate reason for recommending DME to the patient. Doctors are certainly allowed to recommend particular medicines and medical products if they believe the patient has a legitimate medical need. And even if the doctors or company executives prescribed or billed for medical equipment that wasn’t medically necessary, there are administrative and civil penalties for cases of negligence and medical errors.
To secure criminal convictions in this case, the government will have to prove beyond a reasonable doubt that the defendant doctors and medical executives knew that what they were doing was illegitimate, and that they made or received payments to obtain referrals or reimbursements that they knew were illegitimate.
If you have been indicted, targeted, or think you might soon be targeted in one of these investigations, contact us immediately to speak to one of our experienced federal criminal defense attorneys. Our attorneys have successfully defended many people charged with healthcare fraud, bribery, receiving kickbacks, and other related charges. We have the experience, resources and knowledge to fight back and win.
Tom is a trial and appellate lawyer focusing on criminal defense and civil trials. Tom is the author of our firm’s “The Federal Docket” and a contributor to Mercer Law Review’s Annual Survey in the areas of federal law. Tom was named a “Top 40 Under 40” lawyer by The National Trial Lawyers, and is a recognized expert in federal sentencing law. He graduated with honors from the University of Georgia Law School where he served as a research assistant to the faculty in the areas of constitutional law and civil rights litigation. Read Tom’s reviews on AVVO. Follow Tom on Linkedin.