Tag: braces
Jury charges four for scheme involving telehealth, braces
June 1, 2021HME News Staff
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...
Feds charge five in massive fraud scheme
April 29, 2021HME News Staff
NEWARK, N.J. – Five individuals have been charged and two others have pleaded guilty for their roles in a $93 million kickback fraud scheme involving DME and genetic cancer screening, according to the U.S. Attorney’s Office for the District of New Jersey. Thomas Farese, Pat Truglia, Domenic Gatto, Nicholas Defonte and Christopher Cirri are each charged by complaint with conspiracy to commit health care fraud; while Brian Herbstman has pleaded guilty to conspiracy to commit health...
They say crime doesn't pay. In this case, it appears to have bought a yacht.
January 25, 2021Theresa Flaherty, Managing Editor
I received a press release last week from the DOJ about the latest news in Medicare fraud involving, what else, braces!
Juan Camilo Perez Buitrago and two of his employees submitted more than $109 million in false claims for arm, back, knee and shoulder braces. (nothing to see here).
But it’s the details that really made me say, WTF? You see, as part of his scheme, Buitrago had the employees, Jessica Jones and Elizabeth Putulin, list his wife, mother and yacht captain as directors for...
In brief: Bid amounts for braces, changes for CGMs and external pumps, provider reactions
October 30, 2020HME News Staff
WASHINGTON – CMS on Oct. 27 announced Round 2021 single payment amounts for off-the-shelf back braces and knee braces.
The agency has made contract offers for back and knee braces in 127 CBAs, a move that it expects to save $600 million for the Medicare program and beneficiaries over the three-year contract period.
CMS is not making offers for back and knee braces in certain CBAs where savings would not be achieved. Payment in those areas will be based on adjusted fee schedule...
CGS announces reviews for back braces, test strips
August 13, 2020HME News Staff
ATLANTA - CGS has announced that the Jurisdiction B medical review department will begin complex post-pay service-specific reviews on back braces and test strips, according to the van Halem Group. Both reviews are the result of data analysis that indicates the allowed dollars for the two codes in Jurisdiction B are significantly above expected amounts. Each code also ranks high in the CERT Errors Top 15, with L0650 ranking No. 6 and A4253 No. 11, according to the van Halem Group. Based on earlier...
DME owner pleads guilty in latest brace fraud case
July 16, 2020HME News Staff
SAVANNAH, Ga. - Patrick Wolfe, operator of Wilmington Island Medical in Georgia, pleaded guilty to one count of conspiracy for his role in a scheme in which he paid kickbacks in return for leads for DME like orthotic braces and then billed Medicare Part B for the items.This prosecution stems from “Operation Brace Yourself,” a nationwide fraud takedown of a $1.2 billion scheme uncovered in 2019.The combined total of fraud charged in these Georgia cases, which include eight physicians,...
Judge issues first sentence in 'Operation Brace Yourself'
May 8, 2019HME News Staff
SAVANNAH, Ga. - Roderic Bain, the CEO of several DME companies based here, has been sentenced to more than three years in prison for allegedly defrauding Medicare of millions of dollars. Bain, who pleaded guilty to one count of false statements relating to healthcare matters, was also ordered to pay $1.9 million in fines and restitution. It's the first sentence handed down in “Operation Brace Yourself,” a nationwide fraud takedown that saw 24 defendants charged for their roles in a $1.2...
O&P stakeholders take next steps to preserve access
April 26, 2019Theresa Flaherty, Managing Editor
WASHINGTON - O&P stakeholders plan to use a recent massive fraud takedown involving medically unnecessary knee and back braces to advance upcoming legislation.The American Orthotic & Prosthetic Association has been trying to get legislation passed for several years that would curb fraud and abuse, and improve access to clinically appropriate care for beneficiaries.“It's great to see this first wave of charges,” said Todd Eagen, president of the Orthotic Prosthetic Group of America. “I...
Industry knew feds would bust 'obvious' fraud
April 12, 2019Liz Beaulieu, Editor
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...
Feds bust $1.2B brace fraud scheme
April 10, 2019HME News Staff
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...