Billings, MT (WorkersCompensation.com) – The U.S. Department of Justice District of Montana has announced charges involving telemedicine fraud and illegal opioid distribution schemes that resulted in over $6 billion paid out on fraudulent claims.
According to a statement from Justice Department’s Criminal Division Assistant Attorney General Brian C. Rabbitt, there are 345 defendants charged across 51 federal districts with over 100 licensed medical providers, including physicians and nurses, along with other levels of licensed providers. The $6 billion case involves $4.5 billion in alleged fraudulent charges for telemedicine, $845 million in false charges for substance abuse treatment facility claims, and $806 million for other alleged healthcare fraud and opioid distribution schemes.
Per the court documents filed earlier in September, specific executives from Florida based telemedicine company Integrated Support Plus, Inc., allegedly paid licensed practitioners to order and sign for durable medical equipment, testing and medications that were medically unnecessary in exchange for illegal kickbacks. The orders were often signed without seeing the patient, or at best only after a brief telephone call. The charges were then filed to Medicare, as well as other Federal and commercial payers. The case comes on the heels of a much larger investigation in April 2019, Operation Brace Yourself” Telemedicine and Durable Medical Equipment Takedown.
The charges announced on September 30th for $4.5 billion in losses involved 86 defendants across 19 federal jurisdictions. Nurse practitioners Mark Allen Hill of Edenburg, North Dakota, and Janae Nichole Harper of Kalispell, Montana were charged under separate indictments for conspiracy to commit healthcare fraud, and healthcare fraud for allegedly signing orders that did not meet criteria for medical necessity.
Hill’s indictment alleges that he signed orders on unnecessary durable medical equipment, primarily codes L1851 and L1833 that did not meet LCD requirements, that resulted in $10 million in charges, of which Medicare paid $5 million. The indictment for Harper alleges the fraudulent durable medical equipment claims she signed orders for totaled $8 million, of which Medicare paid $4 million. If convicted, both of the practitioners could face a maximum of 10 years in prison and a $250,000 fine. The arraignment date for both Hill and Harper are set for October 27th.