Monday, May 23, 2022

Physician Indicted in $10 Million Telemedicine Health Care Fraud Scheme



 In the years since the Covid shutdown in the spring of 2020, healthcare has seen a steady increase in the use of telemedicine.  It's actually been a bit exciting to see how patients can be helped with the need to actually have doctor and patient in the same room together.

As many of you know, the has also been an increase in teledentistry.  The best part of that, in my opinion, is the ability of hygienists to go into nursing facilities and communicate their findings to a dentist who can then help these patients by either prescription, delegation of treatment, or being able to go on site and know the patient's needs ahead of time.  As more and more people age and end up in skilled nursing facilities, these types of healthcare will become critical.

Of course any system that is created can be hacked or scammed and so it is with telemedicine.  Here is a recent release from the U.S. Department of Justice...

An indictment was unsealed today in federal court in Brooklyn charging Elemer Raffai, an orthopedic surgeon, with health care fraud in connection with a $10 million scheme involving the submission of false and fraudulent claims to Medicare and Medicare Part D plans. Raffai was arrested today and will make his initial court appearance this afternoon in United States District Court for the Northern District of New York.

Breon Peace, United States Attorney for the Eastern District of New York; Kenneth A. Polite, Jr. Assistant Attorney General of the Justice Department’s Criminal Division; Scott J. Lampert, Special Agent-in-Charge, U.S. Department of Health and Human Services, Office of Inspector General’s Office of Investigations (HHS-OIG); and Janeen DiGuiseppi, Special Agent-in-Charge, Federal Bureau of Investigation, Albany Field Office (FBI), announced the arrest and indictment.

“In exchange for kickbacks from telemedicine companies, Dr. Raffai allegedly submitted millions of dollars in false and fraudulent claims to Medicare on behalf of beneficiaries without even examining them or based on conversations on the phone that lasted less than three minutes,” stated United States Attorney Peace. “Dishonest doctors who think Medicare is a cash cow and connect with telemedicine companies to brazenly steal from this vital taxpayer-funded program, will find themselves arrested, prosecuted and their scheme disconnected.”

“These allegations describe a physician who is more motivated by personal enrichment than his duty to provide appropriate and necessary care to his patients,” stated HHS-OIG Special Agent in Charge Lampert. “Dr. Raffai is accused not only of disregarding proper patient care, but also of pilfering funds from a program upon which millions of citizens depend for health services. Our agency and law enforcement partners are dedicated to tracking down individuals who commit health care offenses, and their involvement in a fraud network does not insulate them from our pursuit.”

“Healthcare fraud is a serious crime that impacts every American. Dr. Raffai cheated the system for his own personal gain in the amount of $10 million. Like many others who commit healthcare fraud, Dr. Raffai’s crimes contribute to the rising cost of health care for everyone. The FBI, along with our partners, will continue to investigate healthcare fraud to ensure these individuals who willingly defraud the American people are brought to justice,” stated FBI Special Agent-in-Charge DiGuiseppi.

According to the indictment, Dr. Raffai purported to practice telemedicine with the AffordADoc Network and other telemedicine companies that paid the defendant for each consultation with a beneficiary. Between July 2016 and June 2017, Dr. Raffai allegedly participated in a health care fraud scheme in which he signed prescriptions and order forms via purported telemedicine services for durable medical equipment (DME), including orthotic braces, that were not medically necessary. Dr. Raffai caused the submission of these claims based solely on a short telephone conversation for beneficiaries he had not physically examined and evaluated, and that were induced, in part, by the payments of bribes and kickbacks. Dr. Raffai was paid by telemedicine companies approximately $25 or $30 per patient consultation. The indictment further alleges that Dr. Raffai, together with others, submitted or caused the submission of approximately $10 million in false and fraudulent claims to Medicare for DME on behalf of beneficiaries who were residents of the Eastern District of New York, and Medicare paid more than $4 million on those claims.

The charges in the indictment are allegations, and the defendant is presumed innocent unless and until proven guilty. If convicted, Dr. Raffai faces up to 10 years in prison.

The FBI and HHS-OIG are investigating the case, which was brought as part of the Medicare Fraud Strike Force under the supervision by the U.S. Attorney’s Office for the Eastern District of New York and the Criminal Division’s Fraud Section. Trial Attorneys Andrew Estes and Kelly M. Lyons of the Criminal Division’s Fraud Section are in charge of the prosecution.

The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.


Thursday, May 19, 2022

DENTSPLY SIRONA INC. INVESTIGATION ALERT: Bernstein Liebhard is Investigating DENTSPLY SIRONA Inc. For Violations of the Federal Securities Laws

 Dentsply Sirona has been in the news frequently as of late... and not for good reasons.  It seems that the behemoth company has potentially violated federal securities laws.  The CEO was terminated in a sudden and unanticipated move on April 19th, then the CFO Jorge Gomez left and was hired by vaccine maker Moderna.  One day after Moderna hired him, Gomez was terminated when the company learned that Dentsply Sirona had started an investigation that included him.  This is the kind of thing one expects in a novel, not in the real world.

Now comes a press release from a law firm that is looking to litigate over stock losses of Dentsply Sirona. Here is the press release:

Bernstein Liebhard LLP, a nationally acclaimed investor rights law firm, is investigating potential securities fraud claims on behalf of shareholders of DENTSPLY SIRONA Inc. ("Dentsply Sirona" or the "Company") (NASDAQ: XRAY) resulting from allegations that Dentsply Sirona might have issued misleading information to the investing public.

On April 19, 2022, the Company announced that Donald M. Casey Jr. ("Casey") had been terminated as the Company's Chief Executive Officer ("CEO") and had also ceased to serve as a member of the Board of Directors of the Company, effective that same day. Casey had served as the Company's CEO since joining the Company in February 2018. 

On May 10, 2022, the Company announced its preliminary financial results for the first quarter of 2022. Among other things, the Company reported first quarter net sales decreased 6.1% to $965 million, compared to $1,027 million in the first quarter of 2021. Additionally, net income for the first quarter of 2022 was $65 million, or $0.30 per diluted share, compared to $117 million, or $0.53 per diluted share in the first quarter of 2021. And adjusted earnings per diluted share decreased to $0.52 compared to $0.72 in the first quarter of 2021. 

On that same day, the Company also announced that it was unable to file its Quarterly Report on Form 10-Q for the period ended March 31, 2022.  The Company revealed that in March 2022, an internal investigation had commenced into allegations regarding certain financial reporting matters submitted by current and former employees of the Company.  The investigation was focused on the Company's use of incentives to sell products to distributors in the third and fourth quarters of 2021, whether those incentives were appropriately accounted for, and whether the impact of those sales was adequately disclosed in the Company's periodic reports filed with the SEC. Dentsply also revealed that the Company's Audit Committee was investigating allegations that certain former members of senior management directed the Company's use of these incentives and other actions to achieve executive compensation targets in 2021.  The Audit Committee retained independent outside counsel to assist in its investigation. The Company also announced that it had voluntarily contacted the SEC to advise it that an internal investigation was underway, and that it was unable to file the Form 10-Q on a timely basis.

On this news, the price of Dentsply Sirona stock declined over 7% to close at $36.38 per share on May 10, 2022.

If you purchased Dentsply Sirona securities, and/or would like to discuss your legal rights and options please visit DENTSPLY SIRONA Inc. Shareholder Investigation or contact Peter Allocco at (212) 951-2030 or pallocco@bernlieb.com.

Since 1993, Bernstein Liebhard LLP has recovered over $3.5 billion for its clients. In addition to representing individual investors, the Firm has been retained by some of the largest public and private pension funds in the country to monitor their assets and pursue litigation on their behalf. As a result of its success litigating hundreds of lawsuits and class actions, the Firm has been named to The National Law Journal's "Plaintiffs' Hot List" thirteen times and listed in The Legal 500 for ten consecutive years.

ATTORNEY ADVERTISING. © 2022 Bernstein Liebhard LLP. The law firm responsible for this advertisement is Bernstein Liebhard LLP, 10 East 40th Street, New York, New York 10016, (212) 779-1414. Prior results do not guarantee or predict a similar outcome with respect to any future matter.

Contact Information:

Peter Allocco
Bernstein Liebhard LLP
https://www.bernlieb.com
(212) 951-2030
pallocco@bernlieb.com


Wednesday, May 18, 2022

LIGHTFORCE BRINGS ON FRANK QUINN AS CHIEF REVENUE OFFICER

 LightForce, makers of the world’s only fully customizable 3D

printed braces system, announced that Frank Quinn, former Vice President and General Manager of

US Commercial at Align Technology, has joined the LightForce team as their Chief Revenue Officer.

Frank brings over 13 years of experience in the orthodontics space, helping to drive growth,

revenue, and go-to-market strategies.


“Frank has been a trusted executive in the orthodontics space for over 13 years. He has a long

history of growing companies, and most importantly, scaling the customer-focused values that

make LightForce special,” said LightForce CEO and Co-Founder, Dr. Alfred Griffin, DMD, PhD,

MMSc.


Dr. Griffin continues, “Frank’s orthodontics knowledge, go-to-market expertise, and leadership

experience will be invaluable to both doctors and the LightForce team as the industry makes the

transition to fully digital treatment."

“The industry is shifting to being fully digital and LightForce, with their exponential growth and

buzz in the market, is clearly leading the movement. I’ve been especially impressed by their

community of doctors who are deeply invested and engaged with the LightForce team. There’s

a real shared desire to build something that improves practice efficiency and patient outcomes,”

said Mr. Quinn. “I’m excited to roll up my sleeves with this incredible team to help doctors

provide their patients with the very best orthodontic experience in the specialty.”


About LightForce Orthodontics

LightForce is a digital platform providing orthodontists with fully customized, 3D printed tooth-moving

tools. Founded in 2015 by Dr. Alfred Griffin, DMD, PhD, MMSc, along with Dr. Lou Shuman, DMD,

CAGS, LightForce is revolutionizing the specialty through advanced manufacturing and technology.

After five years of extensive research and development, LightForce launched its first product to the

Orthodontic market- the world’s only fully customized 3D printed bracket system and digital

treatment software. Learn more at www.lf.co.

Tuesday, May 17, 2022

Join Me Tonight for a Presentation on Advanced Digital Caries Detection

 





The good folks at Medidenta have been nice enough to allow me to present this evening.

If you are interested in learning more about devices that can make diagnosing caries easier,  join me for all the low down.

The best part?  It's FREE!

Follow this link to register.  

Monday, May 16, 2022

Keeping Personal and Practice Data Safe in the Wake of the American Dental Association Hack

 A very short post today because the real story is in the link.

A couple of weeks ago, the American Dental Association had their network compromised by cyber criminals.  The hack took the ADA offline for several days and caused a major disruption to not only ADA operations but also the operations of several state dental associations as well.

Even as I type this, their systems are still not back 100%.  This is a big deal and unfortunately it is a situation. that most individuals read or about or experience far too frequently.  It has almost gotten to the point where these situations happen so frequently that the public has become desensitized to them.  We think, 'Oh another data security incident.  Pass the salt." and we carry on our lives.

That's unfortunate, but it is also human nature.  What is *news* is what is not common.  Plane crashes are a big story because they are rare.  If there was 24 hour coverage of every auto fatality, that all the news we would hear, unfortunately.

To help doctors put this event in perspective and also to help them to be prepared, I turned to my friend Steve White.  He is the Senior Partner and Vice President of the cyber security firm DDS Rescue and also someone I've come to have a friendship with where we, once again unfortunately, have bonded over our interest in data security.

Steve's firm is one of my major vendors that helps with my cybersecurity, so when  he speaks, I listen.  I really feel that any doctor, or any individual, who wants to be more secure should listen to him as well.  He was kind enough to answer some questions for me which we've posted to Dental Products Report online.  

Also, if you'd like more info on the ADA incident, after reading the interview on DPR, simply scroll down the page for an article by my buddy Stan Goff dealing with this unfortunate situation.

Thursday, May 12, 2022

Patrick Wardle - From the DPRK With Love

 


If you are a Mac user and you are not yet familiar with Patrick Wardle, I'd highly recommend you check out his blog and his work.  He is a security consultant and pretty much the creme de la creme of Mac experts.  His blog can be found at this link.  

Patrick has devoted himself to the study of Mac malware, even going so far as to finding vulnerabilities in both applications and the Mac Operating System itself.  He also runs a 501(c)(3) foundation devoted to the study of and solutions to Mac problems and malware.

Through his foundation "Objective See" he also releases tools/applications that help Mac users monitor vital functions, locate unwelcome processes, and become aware of potential "bad things" happening in places most of us would never look.  Oh, and did I mention that he provides these tools for FREE?  

Patrick has a long history of working in the security arena and he's one of those individuals who, when he speaks, the industry listens... and rightly so.

On a personal note, I've never met Patrick face to face, but we've corresponded a bit and I've come away impressed.  It's a given that a guy like this is smart.  However, it's rare these days to find someone who is doing the right thing simply because it's the right thing to do.  Because of that, I highly recommend supporting Patrick through Patreon.  That allows him to continue the good fight and to help provide the community with high quality and effective tools.


Now on to the heart of today's post.  If you follow the security industry and read what's been going on the past few months, you've seen that North Korea has put forth a lot of effort in attempting to compromise security researchers in an attempt to learn better ways to break into systems.  North Korea is under an incredible number of sanctions that limit their ability to earn money that the country wants to spend in its nuclear weapons program.

The North Korean economy is floundering and because of that, their government sponsored hackers have been working hard to break into banks and basically find any way possible to bring money into North Korean coffers.

The latest efforts they've put forth are in the areas of cryptocurrency and the blockchain.  Obviously their hope is to make off with cash from different sources.  These attempts to steal crypto and hack the blockchain were publicized by the U.S. Cybersecurity & Infrastructure Security Agency (often abbreviated as CISA).  Objective See has analyzed the Mac parts of this and Patrick has posted his analysis.

He recently put up a blog post about this situation which is a fascinating read.  

Wednesday, May 11, 2022

Reward Offers for Information to Bring Conti Ransomware Variant Co-Conspirators to Justice

 


This is an interesting piece of news.  The US Department of State has decided to dial up the pressure on the Conti ransomware gang.  This group has been pretty prolific and in addition to making tons of money in ransom, they have also wrought havoc on a number of U.S. businesses and industries in general.  If you have any interest, just type "Conti" into Google and see the number of hits...


What follows is the Press Statement from the U.S. Department State:

The Department of State is offering a reward of up to $10,000,000 for information leading to the identification and/or location of any individual(s) who hold a key leadership position in the Conti ransomware variant transnational organized crime group.  In addition, the Department is also offering a reward of up to $5,000,000 for information leading to the arrest and/or conviction of any individual in any country conspiring to participate in or attempting to participate in a Conti variant ransomware incident.

The Conti ransomware group has been responsible for hundreds of ransomware incidents over the past two years.  The FBI estimates that as of January 2022, there had been over 1,000 victims of attacks associated with Conti ransomware with victim payouts exceeding $150,000,000, making the Conti Ransomware variant the costliest strain of ransomware ever documented.  In April 2022, the group perpetrated a ransomware incident against the Government of Costa Rica that severely impacted the country’s foreign trade by disrupting its customs and taxes platforms.  In offering this reward, the United States demonstrates its commitment to protecting potential ransomware victims around the world from exploitation by cyber criminals.  We look to partner with nations willing to bring justice for those victims affected by ransomware.

This reward is offered under the Department of State’s Transnational Organized Crime Rewards Program (TOCRP).

The Department manages the TOCRP in close coordination with our federal law enforcement partners as part of a whole of government effort to disrupt and dismantle transnational organized crime globally, including cybercrime.  More than 75 transnational criminals and major narcotics traffickers have been brought to justice under the TOCRP and the Narcotics Rewards Program (NRP) since 1986.  The Department has paid more than $135 million in rewards under these programs to date.

For more information on the group listed above and the TOCRP, please see Department of State INL Transnational Organized Crime Rewards.