Surgeon Charged in $10M Telemedicine Fraud Scheme
A New York-based orthopedic surgeon was charged in a telemedicine fraud scheme that allegedly bilked Medicare out of $10 million.
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By - The Department of Justice announced that orthopedic surgeon Elemer Raffai, MD, has been indicted in a telemedicine fraud scheme that involved the submission of false and fraudulent claims to Medicare.
Raffai, who was arrested, appeared in the United States District Court for the Northern District of New York on April 21. If convicted, he faces up to 10 years in prison.
Per the indictment, Raffai took part in a fraud scheme between July 2016 and June 2017 that involved him signing prescriptions and order forms through alleged telemedicine services to obtain durable medical equipment that was not medically necessary. The surgeon has been accused of submitting claims based on short telephone conversations with beneficiaries he had not physically examined. These actions were driven in part by bribes and kickbacks.
Raffai received $25 or $30 per patient encounter, altogether resulting in $10 million in false claims to Medicare, the DOJ stated.
“Dishonest doctors who think Medicare is a cash cow and connect with telemedicine companies to brazenly steal from this vital taxpayer-funded program will find themselves arrested, prosecuted, and their scheme disconnected," stated United States Attorney for the Eastern District of New York Breon Peace in the press release.
The investigation of this case involved the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services' Office of Inspector General (HHS-OIG). The case was brought as part of the Medicare Fraud Strike Force, which leverages data analytics and the resources of federal, state, and local law enforcement entities to combat healthcare fraud, waste, and abuse.
“Healthcare fraud is a serious crime that impacts every American. Dr. Raffai cheated the system for his own personal gain in the amount of $10 million. Like many others who commit healthcare fraud, Dr. Raffai’s crimes contribute to the rising cost of healthcare for everyone,” stated FBI Special Agent-in-Charge Janeen DiGuiseppi in the press release.
“The FBI, along with our partners, will continue to investigate healthcare fraud to ensure these individuals who willingly defraud the American people are brought to justice,” continued DiGuiseppi.
Further, the Centers for Medicare and Medicaid Services and the HHS-OIG have been engaging in actions to prevent fraudulent activities in the telehealth arena.
There have been various cases involving false claims related to telehealth visits in the recent past.
Last week, Physician Partners of America (PPOA) and two of its leaders paid $24.5 million to settle allegations of fraud. Specifically, they were accused of fraudulently billing federal and state healthcare programs for unnecessary services. Per the allegations by the US and the state of Florida, PPOA periodically scheduled telehealth appointments that were not needed.
In addition, at the end of 2021, four individuals were charged for their involvement in a telemedicine fraud scheme that cost public and private payers $37 million.
