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.

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