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False Telemedicine Sessions at Center of Federal Fraud Crackdown

A telemedicine program in San Diego is the latest to face federal fraud charges in a national crackdown on schemes netting billions of dollars in insurance reimbursements for non-essential drugs and fake treatments.

Source: ThinkStock

By Eric Wicklund

- Law enforcement officials are beginning to catch up to healthcare providers who see telehealth as a means of stealing from the government.

The latest case comes out of San Diego, where a nurse practitioner pled guilty this week to taking part in a sham telemedicine program that allegedly bilked the US government’s TRICARE program out of more than $65 million.

That case, meanwhile, is part of a federal crackdown launched in July 2017 by then-US Attorney Jeff Sessions that is responsible for more than $2 million in fraudulent billings to Medicare, Medicaid and other insurers for services and prescriptions that were either unnecessary or never used. To date, more than 600 people have been charged.

“The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims,” the Justice Department said in a statement. 

Candace Michelle Craven’s guilty plea this week in a San Diego federal courthouse makes her the fourth of seven defendants in the case to admit guilt. According to court records and media reports, Craven, an employee of Tennessee-based Choice ND, was part of a team that recruited San Diego-area Marines and their dependents to seek specialty medications that would be covered by TRICARE.

Law officials say the team, which included a physician and two chiropractors, paid the Marines and their dependents to file prescriptions with pharmacies controlled by co-conspirators following a telephone consult that was described as a telehealth visit.  The prescriptions were signed by Choice MD doctors and billed to TRICARE.

By the time TRICARE stopped its practice of reimbursing for the prescriptions, the scam allegedly resulted in 4,442 prescriptions netting more than $65.6 million.

In Tennessee, four men and seven companies have been charged in a 32-count federal indictment for allegedly netting more than $1 billion in a scheme tied to false telehealth sessions.

According to the indictment, the men created a scheme in which HealthRight – a telemedicine company with locations in Florida and Pennsylvania - fraudulently solicited insurance coverage information and prescriptions from consumers across the country for prescription pain creams and other similar products.

“The indictment states that doctors approved the prescriptions without knowing that the defendants were massively marking up the prices of the invalidly prescribed drugs, which the defendants then billed to private insurance carriers,” Justice Department officials said in a press release.

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