Feds announce guilty plea in $44M telemedicine fraud scheme

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A telemedicine fraud scheme racked up $44 million in bills for medically unnecessary durable medical equipment (DME), according to federal investigators.

Meanwhile, in a separate case, a federal jury convicted a physician of unlawfully distributing opioids including oxycodone and morphine for years, “regularly ignoring the signs of drug abuse and addiction in his patients.”

The cases were announced this week by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG).

Unneeded equipment

According to DOJ, David Santana, 38, the owner of Conclave Media doing business Nationwide Health Advocates, pleaded guilty to a $44 million telemedicine fraud scheme for working to prescribe unnecessary items, including orthotics and genetic tests.

Santana has agreed to plead guilty to conspiracy to commit health care fraud, according to DOJ.

From January 2018 to August 2021, the company based in Methuen, Massachusetts, engaged telemarketing companies to generate leads by targeting Medicare beneficiaries. The telemarketers paid Santana’s companies on a per-order basis to generate orders for DME and genetic testing, according to DOJ.

Santana allegedly tracked down physicians and nurses willing to review and sign prepopulated orders, typically with no contact with the beneficiaries, but falsely portraying legitimate examinations.

“It is alleged that Santana knew these DME suppliers and laboratories would use the signed orders to submit claims to Medicare for DME and genetic testing that were medically unnecessary, based on false documentation and tainted by kickbacks,” the DOJ announcement said. Santana could face up to 10 years in prison and a fine up to $250,000 or twice the gross financial gain or loss, according to the federal investigators.

Dealing in opioids

Bowdoin G. Smith, DO, 67, of Carthage, Tennessee, had a general practice medical clinic “where he knowingly prescribed opioids outside the usual course of professional practice and without a legitimate medical purpose,” according to DOJ.

Smith’s medical license was put on probation for three years starting in 2012, and when probation was lifted, Smith regularly wrote more unlawful prescriptions from 2016 to 2019. Smith could face up to 20 years in prison, according to the federal investigators.

Smith’s medical license remained current with an expiration date of Oct. 31, 2023, according to the licensing website of the Tennessee Department of Health.