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In shocking news coming out of Kalispell, MT, two nurse practitioners have been indicted and accused of a ten million dollar telemedicine fraud scheme. The U.S. Attorney’s Office for the District of Montana and the U.S. Department of Justice announced this on Wednesday.
The case–with stunning fraud levels–is a first in its magnitude. Acting Assistant Attorney General Brian C Rabbitt stated:
“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,”
The two defendants are Janae Nichole Harper, 33, of Kalispell and Mark Allen Hill, 54, from North Dakota. The accusation is that the pair both received money to sign brace orders which were never needed. It is alleged that in most cases these orders were never even discussed with the beneficiary as to whether or not they were required.
Hill is alleged to have signed for over ten million dollars in Medicare claims, all medical orders for braces. Of those ten million dollars of orders, the US government paid just over five million. Harper’s indictment is similar with more than eight million dollars in orders, of which just over four million dollars was paid.
This is no small fraud; over 345 defendants across more than 50 federal districts were charged as part of the scheme. Somewhat more shockingly, the list includes 100 licensed medical professionals, many of whom are doctors and nurses. Rabbitt, from the Justice Department’s Criminal Division, went on to say:
“These cases hold accountable those medical professionals and others who have exploited health-care benefit programs and patients for personal gain.”
Today, in fact, saw the biggest single charge in conjunction with this action. A cool four and a half billion dollars was announced as having been racked up in falsified claims across nineteen judicial districts. Rabbitt was keen in the press conference to show that this will be treated with the full force of the law:
“The cooperative law enforcement actions announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a national health emergency.”
This telemedicine fraud scheme was allowed to carry on for a long time, and the question is how and why? Court documents indicate that executives from telemedicine offered cash for the falsified orders of durable medical equipment (DME). This would happen with zero or little interaction with the patient.
The next stage of the telemedicine fraud scheme was for the DME companies or genetic testing firms to purchase those orders in return for a cash handshake. We covered one such company here, as Anthem Inc. was charged. Such a scheme involves false orders, fake purchases and then illegal claims made to Medicare or insurers, the perfect play.
This comes following a huge crackdown since 2019, as part of “Operation Brace Yourself” which was solely aimed at this kind of telemedicine fraud scheme. So far it is estimated that over one and a half billion dollars has been avoided thanks to this pursuit of fraudsters.
The Medicare industry has been at risk of this for a very long time, as big data has helped push forward the advancement of telemedicine, which we cover in this piece. Something we also looked into as early as March of last year, was the gaps in security of Electronic Health Record management. This is exactly why these crackdowns have come about.
If Hill and Harper are convicted of the charges against them, they each face a decade in prison, along with a quarter million dollar fine too. This fee seems light given that they have been charged with submitting over eighteen million dollars of false claims.
The two defendants will be arraigned on October 27 before Magistrate Judge John T. Johnston at Great Falls. Prosecuting will be Asst. U.S. Attorney Michael A. Kakuk and Robyn N. Pullio, trial attorney, Fraud Section, Criminal Division of the Justice Department.
The hundreds of others who are accused in this telemedicine fraud charge are being arraigned across the country in the coming month, with very similar sentences hanging over their heads.