Home Health Orthopedic surgeon arrested in $10 million telehealth fraud case

Orthopedic surgeon arrested in $10 million telehealth fraud case

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The U.S. Attorney’s Office for the Eastern District of New York announced Thursday that an orthopedic surgeon had been arrested and charged with healthcare fraud.

According to a press release, the surgeon, 56-year-old Dr. Elemer Raffai, is accused of allegedly submitting false claims to Medicare in exchange for kickbacks from telemedicine companies.  

“These allegations describe a physician who is more motivated by personal enrichment than his duty to provide appropriate and necessary care to his patients,” said HHS-OIG Special Agent in Charge Scott J. Lampert in a statement.   

“Dr. Raffai is accused not only of disregarding proper patient care, but also of pilfering funds from a program upon which millions of citizens depend for health services,” Lampert continued.   

WHY IT MATTERS  

According to the indictment, which was unsealed this week, Raffai was paid by telemedicine companies for each consultation with a beneficiary.   

Between July 2016 and June 2017, said the Justice Department, Raffai allegedly signed prescriptions and order forms for durable medical equipment, including orthotic braces, that were not medically necessary.   

“Dr. Raffai caused the submission of these claims based solely on a short telephone conversation for beneficiaries he had not physically examined and evaluated, and that were induced, in part, by the payments of bribes and kickbacks,” said the U.S. Attorney’s Office press release.   

In return, said the agency, telehealth companies allegedly paid Raffai about $25 or $30 per patient consultation.   

Raffai, together with others, is allegedly connected to the submission of approximately $10 million in fraudulent claims to Medicare. Medicare paid more than $4 million on those claims.

“In exchange for kickbacks from telemedicine companies, Dr. Raffai allegedly submitted millions of dollars in false and fraudulent claims to Medicare on behalf of beneficiaries without even examining them or based on conversations on the phone that lasted less than three minutes,” said United States Attorney Breon Peace. 

“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,” Peace added.  

The department noted that the charges are allegations and that Raffai is presumed innocent until proven guilty. If convicted, he faces up to 10 years in prison.  

In 2019, the CEO of AffordaDoc, one of the companies named in Raffai’s indictment, admitted to paying illegal kickbacks to healthcare providers to order medically unnecessary braces for Medicare beneficiaries.

THE LARGER TREND  

Federal law enforcement has brought the hammer down on alleged telehealth fraud in several highly publicized cases. In September 2021, the DOJ accused upwards of 43 people in 11 judicial districts of participating in a variety of telemedicine-related schemes.

That move followed the news in February 2021 that a Florida woman had pleaded guilty to conspiracy to commit healthcare fraud and filing a false tax return, in what special agents described as “telefraud.”  

ON THE RECORD  

“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,” said FBI Special Agent-in-Charge Janeen DiGuiseppi regarding Raffai’s case.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

Source : Healthcare IT News

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news7.asia Orthopedic surgeon arrested in $10 million telehealth fraud case