SAVANNAH, GA. — More than 40 people are facing federal charges for their alleged roles in health care fraud schemes in South Carolina and Georgia that resulted in hundreds of millions of dollars in fraudulent billings.
Peter M. McCoy Jr., United States attorney for the District of South Carolina, and Bobby L. Christine, United States attorney for the Southern District of Georgia, announced the charges at a news conference Wednesday morning at the federal courthouse in Savannah.
South Carolina is a part of the Fourth Circuit, which includes Maryland, Virginia, West Virginia, and North Carolina.
Georgia is a part of the 11th Circuit, which includes the states of Alabama and Florida. The state is apportioned into three separate federal court districts, southern, middle and northern. The southern district has six divisions: Augusta, Brunswick, Dublin, Savannah, Statesboro, and Waycross.
“Those who steal from federal health care programs are taking money from the pockets of taxpayers. This is reprehensible,” McCoy said. “Along with our federal law enforcement partners and our colleagues in the Southern District of Georgia, we have worked tirelessly to identify and prosecute those who seek to harm the citizens of South Carolina and Georgia. We have also ensured that millions of dollars have been returned, or will be returned, to these essential health care programs.”
“This coordinated, deliberate and methodical series of investigations and prosecutions in the Southern District represents an ongoing, exhaustive team effort with our law enforcement partners to protect the taxpayers’ safety net programs from fraud and theft,” Christine said. “The warning should now be abundantly clear: Unscrupulous providers will find themselves in hot water if they attempt to illegally enrich themselves from these programs.”
The federal filings allege that the criminal network targeted by these investigations involves individuals and companies that collect patient data and sell it to one or more durable medical equipment suppliers, pharmacies, or labs. Patients were often lured into the scheme by an international telemarketing network. The co-conspirators’ promise of often inappropriate durable medical equipment, test results, and medication misled patients and delayed their chance to seek appropriate treatment for medical complaints. As part of these schemes, telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.
The filings also allege that durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.
The charges mark the third in a nationwide series of telemedicine fraud prosecutions, which began through investigative efforts out of the District of South Carolina.
In the District of South Carolina, last week four individuals were charged in a telemedicine-based health care fraud and kickback conspiracy, involving more than $100 million dollars in fraudulent billings in South Carolina. The individuals were all medical providers - four doctors and one nurse - who signed prescriptions over a web-based platform, often times without meeting or speaking with the patients. Additionally, charges were filed against eight individuals and one corporation related to a health care fraud and kick back conspiracy that used offshore call centers and fraudulent telemedicine to bill hundreds of millions of dollars for durable medical equipment that was not medically necessary. These charges are in addition to the dozens of individuals previously charged.
In the Southern District of Georgia, four individuals were charged in the last week for telemedicine-based fraud and kickback schemes, adding to the 26 defendants charged previously. The four new defendants, three of whom were medical professionals, were alleged to have participated in this telemedicine-based scheme, which now collectively totals in excess of $1.4 billion in fraudulent claims for defendants charged in the Southern District of Georgia alone. Among the recent defendants charged, a former compliance officer was charged with conspiracy to commit health care fraud for her role as part of a company that connected various parties through an online-based platform where patients’ health information would be uploaded, prescriptions would be signed electronically by medical professionals, and the package of health information with a signed prescription could then be sold to durable medical equipment companies for eventual billing to Medicare and other programs.
Under nationwide operations Brace Yourself, Double Helix, and Rubber Stamp, the districts have obtained the convictions of the owners of international telemarketing firms; owners of genetic testing centers; owners of pharmacies; owners of medical supply businesses; CEOs of marketing companies; compliance officers; doctors; and nurses.
The district of South Carolina has led this charge.
Cases have been brought in 20 federal district courts, resulting in over 175 individuals being charged and or convicted, with over a billion dollars in restitution, as the districts work with the Health Care Fraud Strike Force of the department of justice.
Additionally, the Centers for Medicare and Medicaid Services/Center for Program Integrity separately took the largest number of adverse administrative actions resulting from a single administrative health care fraud investigative initiative in history in revoking the Medicare billing privileges of over 250 additional medical professionals for their involvement in telemedicine schemes.
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