Tag: Fraud

BOSTON – Blue Cross Blue Shield of Massachusetts is warning members to be vigilant, as scams offering free DME and pharmacy products are on the rise. Medicare beneficiaries and patients who've had a recent injury or surgery are often targeted by scammers, it says. In many cases, the perpetrators solicit physicians to sign off on unnecessary orders or prescriptions, such as back braces or pain cream, which are then improperly billed to a patient's health insurer. "While these types of...

ATLANTA – Kevin Rumph Jr., a Department of Veterans Affairs employee, has pleaded guilty to using his department-issued credit card to buy more than $1.9 million worth of CPAP equipment between 2013 and 2021, which he then stole and sold. Rumph worked in the VA’s Prosthetic Department at its Community Based Outpatient Clinic (CBOC) located at Fort McPherson in Atlanta, where his duties included purchasing a wide variety of medical equipment. Rumph used his government-issued purchase card...

GROVE CITY, Ohio – A federal grand jury has returned a 24-count indictment charging four individuals for their roles in an alleged fraud scheme that led to more than $20 million in false claims to the Medicare program, according to the U.S. Attorney’s Office for the Northern District of Ohio. Two defendants, Elizabeth Baljak and Megan Ilg are accused of signing prescriptions for medical braces regardless of medical necessity, without a physical exam and frequently without any contact...

ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association expects a companion bill to H.R. 1990 to be introduced in the Senate soon. The bill includes provisions that would prohibit the use of drop shipping to deliver orthoses that are not specifically designated as off-the-shelf orthoses. AOPA believes the bills, if passed, would go a long way to curb fraud and abuse through the delivery of medically unnecessary orthoses to Medicare beneficiaries. “AOPA remains...

RALEIGH, N.C. – A Perfect Fit for You, a DME provider owned by Margaret Gibson, was ordered to pay a $2 million fine and more than $10 million in restitution to the North Carolina Medicaid program for alleged fraudulent claims submitted by employees for DME between March 2015 and November 201. In some cases, the identifying information of deceased beneficiaries was allegedly used. A civil claim under the federal and state False Claims Act was also filed against...

WASHINGTON - The Department of Health and Human Services Office of Inspector General, along with state and federal law enforcement partners, has conducted a national “telefraud” takedown involving more than $6 billion in alleged losses. The fraudulent activity has resulted in charges for 345 defendants, including telemedicine companies, DME companies, genetic testing labs, pharmacies and more than 100 medical practitioners, in 51 judicial districts. Health care billing privileges have...

WASHINGTON - The owner and CEO of a telemedicine company has pleaded guilty to a $424 million conspiracy to defraud Medicare and receive illegal kickbacks in exchange for DME orders, the Department of Justice has announced.Lester Stockett, the owner of Video Doctor USA and Telemed Health Group, has pleaded guilty to one count of conspiracy to defraud the United States and pay and receive healthcare kickbacks, and one count of conspiracy to commit money laundering. In connection with his plea agreement,...

YARMOUTH, Maine - Accreditation organizations help to prevent and eliminate fraud, waste and abuse in the Medicare program, but it's not their main job, they say. After news broke earlier this year of “Operation Brace Yourself,” a $1.2 billion fraud scheme involving medical unnecessary braces, HME providers shook their heads wondering, “How are they accredited?” The scheme involved illegal kickbacks and bribes by HME providers in exchange for referrals of beneficiaries by...

WASHINGTON - HME industry stakeholders aren't surprised by a $1.2 billion fraud scheme involving medically unnecessary braces and they're glad to see “bad actors” punished. The feds last week charged 24 defendants with an alleged scheme involving illegal kickbacks and bribes by DME companies in exchange for referrals of Medicare beneficiaries by medical professionals working with fraudulent telemedicine companies for back, shoulder, wrist and knee braces. “Stakeholders...

WASHINGTON - The federal government has charged 24 defendants, including executives at five telemedicine companies, the owners of dozens of DME companies and three licensed medical professionals, for their roles in a healthcare fraud scheme that resulted in $1.2 billion in losses.In addition, CMS's Center for Program Integrity has taken adverse administrative action against 130 DME companies that submitted more than $1.7 billion in claims and were paid more than $900 million.The charges target an...