The caller said he was with Medicare.
And yet, not just one, but 13 braces arrived soon afterward at Ernest's house in central
Medicare, the federal taxpayer-supported health care insurance program for older Americans, had paid more than
The orders came from four medical equipment companies and were prescribed by four separate health care professionals - a prescription being required to receive an orthotic brace. But Ernest said he didn't talk to any doctors during the phone call.
That's how the latest Medicare frauds work, said
"Sometimes the teledoctors will come on the line and ask real Mickey Mouse questions, stuff like, "Do you have any pain?" explained Rabinovic. "But oftentimes, there is no contact between the doctor and the patient before they get the braces. And in almost all of the cases, the person prescribing the braces is somebody the Medicare beneficiaries don't know."
While prescriptions for durable medical equipment, such as orthotic braces or wheelchairs, have long been a staple of Medicare fraud schemes, the manipulation of telemedicine is relatively new. The practice appears to be increasing as the telemedicine industry grows.
"This has put telemedicine scams on Medicare's radar with growing urgency," said
In the past year, the
Often the doctors working for these outfits don't perform medical consultations, but rather write prescriptions without talking to patients, as in Ernest's case. Of course, that is not how telemedicine is designed to work.
The DOJ charged 24 people, including three medical professionals and the corporate executives of five telemedicine companies.
According to federal court documents,
Federal investigators allege that through Integrated Support Plus, McNeal hired and paid a
DeCorso admitted to writing medically unnecessary brace orders for telemedicine companies without speaking to beneficiaries or doing physical exams. He also admitted that his conduct resulted in a
McNeal got the Medicare beneficiaries' information for DeCorso to write the prescriptions from telemarketing companies, according to the indictment. Then, authorities allege, McNeal sent the prescriptions back to the same telemarketing companies in exchange for payments described as kickbacks and bribes.
Federal investigators allege these telemarketing companies sold the prescriptions to the durable medical equipment companies, who in turn billed Medicare for the braces.
McNeal's lawyer said he could not discuss his client's case because it is pending. DeCorso's lawyer did not respond to multiple requests for comment.
It's clearly a profitable business. Taxpayers are the ones who ultimately pay for Medicare fraud, which often leads to higher health care premiums and out-of-pocket costs.
Medicare spending on back, knee and ankle braces highlighted in the inspector general's investigations increased by over
In an April news release about Operation Brace Yourself, Assistant Attorney General
"These are actually really sketchy online marketing companies participating in these schemes who are billing themselves as telemedicine," said Lacktman, who works in the
All of this comes at a time when Medicare and Medicare Advantage are expanding telemedicine, though the programs have been slower to adopt it than the private sector, said
"I would hate for Medicare to fall even further behind with telehealth," said Laemmle-Weidenfeld, who previously worked in the Fraud Section of the DOJ's Civil Division. "The vast majority of telehealth providers are legitimate, but as with anything there are a few bad apples," she said.
Even with the recent federal busts, the scams continue.
But Ernest can't change his phone number because it's the main line associated with his painting business.
"It really drives me crazy," said Ernest. "How many people are they ripping off?"
Caption: Thirty people from across