A Texas man was sentenced to 90 months in prison for his role in a $59.9 million scheme involving medically unnecessary durable medical equipment billed to Medicare, according to a March 9 news release from the Justice Department.
The move comes after CMS implemented a six-month nationwide moratorium on new Medicare enrollment for certain DMEPOS suppliers, including initial enrollment applications and some changes in majority ownership, citing disproportionate high-risk billing by medical supply companies.
What happened?
- Patrick Cassells, from Fulshear, Texas, owned and operated three DME companies and concealed his role in one of the businesses by listing another individual as the sole owner and manager on a Medicare enrollment application.
- Mr. Cassells paid illegal kickbacks to co-conspirators who sent signed physicians’ orders and paperwork used to bill Medicare for orthotic braces, including knee, back, shoulder and wrist braces. The kickbacks were disguised as payments for “leads” and “marketing.”
- Based on the orders, issued without physicians examining or treating patients, Mr. Cassells submitted claims falsely stating the braces were medically necessary. Through the three companies, he caused more than $59.9 million in fraudulent Medicare claims, for which the program paid more than $27 million.
- Mr. Cassells pleaded guilty in June 2024 to one count of conspiracy to commit healthcare fraud. In addition to the prison sentence, he was ordered to pay $25.4 million in restitution and forfeiture and to forfeit four vehicles and three properties.
