Since March 24, the Justice Department has sentenced, accused or settled with three physicians and one durable medical equipment company owner for fraud cases.
The activity comes as CMS is currently enforcing a six-month nationwide moratorium on new Medicare enrollment for certain DME suppliers. Overall, there have been at least seven cases during this period.
CMS said it stopped more than $1.5 billion in suspected fraudulent durable medical equipment, prosthetics and orthotics suppliers billing last year. According to a CMS action notice, the moratorium applies to seven supplier specialty categories: medical supply companies; medical supply companies with orthotics personnel; with pedorthic personnel; with prosthetic personnel; with prosthetic and orthotic personnel; with a registered pharmacist; and with a respiratory therapist. During the moratorium, no new suppliers in those categories may enroll in Medicare, and new practice locations are barred when they qualify as initial enrollments.
Here are the four cases since March 24:
- Robert Smith III, of Archer City, Texas, was sentenced to 150 months in prison for organizing and leading a $61.5 million healthcare fraud conspiracy involving thousands of Medicare beneficiaries. Mr. Smith owned and operated seven DME supply companies through which he submitted millions of dollars in false claims to Medicare for medically unnecessary orthotic braces and foot baths.
- Maryland OB-GYN Valinda Nwadike, MD, agreed to pay $507,500 to resolve False Claims Act allegations related to a telemarketing scheme designed to defraud Medicare and TriCare. Between November 2014 and January 2018, Dr. Nwadike allegedly created and signed thousands of fraudulent prescriptions for compounded drugs and DME following cursory phone calls with patients, without physically examining them or reviewing their medical histories.
- Alabama physician Tommie Robinson, MD, was sentenced to 16 months in prison for a $2.7 million telemedicine fraud scheme involving medically unnecessary DME and genetic testing. Between December 2018 and March 2021, Dr. Robinson worked with telemedicine companies to sign pre-populated physicians’ orders for Medicare beneficiaries with whom he had no provider-patient relationship. As a result, suppliers and laboratories submitted more than $2.7 million in claims to Medicare for medically unnecessary services based on false documentation.
- Florida physician Simon Grinshteyn, MD, pleaded guilty to making false statements in connection with a multimillion-dollar healthcare fraud scheme involving medically unnecessary genetic testing and durable medical equipment. Dr. Grinshteyn worked with a purported telemedicine company between February and June 2020 to sign pre-populated medical documentation and physicians’ orders for Medicare beneficiaries with whom he had no provider-patient relationship. As a result, Medicare paid more than $3.1 million in claims based on false documentation.
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