Telemedicine Fraud Scheme Results in Civil and Criminal Enforcement Actions Against Practitioners
On August 24, 2021, the United States Department of Justice announced civil and criminal enforcement actions against several medical practitioners for signing off on illegitimate orders for medical braces and cancer genetic testing promoted by telemarketers.
Medicare beneficiaries at the center of the scheme were “bombarded” by calls from an overseas telemarketing company offering “free” braces. The DOJ alleges that if the doctors involved had taken the time to listen to the recorded calls, they would know the calls were run by non-practitioner telemarketers. The practitioners would sign off on medically unnecessary braces, which the beneficiaries often did not want and/or did not use.
Individuals Involved
Richard Laksonen is a nurse practitioner from Michigan who pled guilty to one count of making a false statement regarding to health care matters. Laksonen admitted that he signed off on orders for medical braces and cancer genetic testing without actually reviewing the records to confirm that the proper assessments had been done and that the orders were reasonably and medically necessary. Laksonen admitted that within one week time, he signed more than 330 single-patient files, many containing multiple types of braces, after reviewing each file for an average of 18 seconds. Laksonen continued to approve the orders even after a health insurer investigator warned him that the patient referrals were the result of aggressive telemarketing. Laksonen is responsible for more than $5.7 million in improper payments made by Medicare. His sentencing date is set for November 15, 2021.
In addition to Laksonen, three doctors of Michigan entered into civil settlements for alleged violations of the False Claims Act. Hugh G. Deery II, MD, Colleen Browne, DO, and Mosab Deen, DO, all approved orders for medically unnecessary braces and cancer genetic testing, despite red flags indicating that the items were illegitimate. The DOJ noted that there were many situations were the brace order and the “examination” notes signed by the physician had discrepancies. Additionally, the telemarking company often suggested that the physician sign multiple brace orders for each beneficiary and pressured the doctors to approve all claims.
As noted above, the three doctors entered into civil settlements to resolve their individual liability. Dr. Deery has agreed to pay $301,140. Dr. Browne has agreed to pay $42,000. Dr. Deen has agreed to pay $28,545. Dr. Browne’s settlement also resolves allegations that she ordered medically unnecessary cancer genetic testing for cancer screening purposes as Medicare does not generally cover genetic testing just for the sole purpose of screening for cancer.
The Investigation Continues
“As medical professionals, these defendants had an obligation to conduct a good faith review of the devices and medical tests being ordered on behalf of Medicare patients,” said Timothy Waters, Special Agent in Charge of the FBI’s Detroit Field Office. “Their failure to do so contributes to the billions of dollars of fraud losses Medicare suffers annually. Collaborative efforts like this one, demonstrate the FBI and our partners resolve to hold accountable those seeking to defraud the Medicare system.”
This investigation – known as Operation “Happy Clickers” – is ongoing with input from the United States Department of Health and Human Services Office of Inspector General (HHS OIG), Federal Bureau of Investigation (FBI), and the United States Attorney’s Office for the Western District of Michigan.