In addition, the Center for Medicare Services Center for Program Integrity (CMS/CPI) administrative action against 130 DME companies that received more than $900 million after submitting over $1.7 billion in claims, Carpenito said.
"Today, one of the largest healthcare fraud schemes in USA history came to an end", said Robert Johnson, assistant director of the Federal Bureau of Investigation, one of several agencies involved.
The U.S. Department of Justice has announced the culmination of a massive investigation into an worldwide network of telemedicine companies, device makers and healthcare providers, claiming they sold medically unnecessary orthotic braces to patients and sent the bills on to Medicare, totaling over $1.2 billion in fraudulent claims.
In the scheme, "telemarketers" called seniors offering orthopedic braces that had been advertised on television and radio.
The ringleaders paid doctors to prescribe the equipment either without any patient interaction or with only a brief phone call "with patients they had never met or seen", the US attorney said.
"Proceeds of the fraudulent scheme were allegedly laundered through worldwide shell corporations and used to purchase exotic automobiles, yachts and luxury real estate in the United States and overseas", DOJ said in a statement.
"These defendants - who range from corporate executives to medical professionals - allegedly participated in an expansive and sophisticated fraud to exploit telemedicine technology meant for patients otherwise unable to access health care", Assistant Attorney General Benczkowski said in a statement on Tuesday.
In this photo provided by the Department of Health and Human Services, Office of Inspector General, HHS Office of Inspector General agents, and other law enforcement officers, take part in arrests Tuesday, April 9, 2019, in Queens, N.Y., as they break up a billion-dollar Medicare scam that peddled unneeded orthopedic braces to hundreds of thousands of seniors nationwide, using a network of foreign call centers. Charges were being brought against defendants in California, Florida, New Jersey, Pennsylvania, South Carolina and Texas.
The fraudulent call centers were based in the Philippines and throughout Latin America. As the investigation progressed, Cantrell said, federal agents gained cooperation from people familiar with the various schemes.
The charges stem from "their alleged participation in a $454 million illegal health care kickback and worldwide money laundering scheme related to the solicitation of illegal kickbacks and bribes in exchange for the referral of durable medical equipment (DME) companies orders to DME providers".
CEOs and COOs and associates with five telemedicine companies, owners of DME companies, and three licensed medical professionals were among the 24 people charged. In several cases telephone numbers associated with the individuals were disconnected. The tele-medical companies and the doctors had not previously done physical examinations on patients who had Medicare benefits. The true extent of it is unknown, and some cases involve gray areas of complex payment policies. Law enforcement coordination has grown, with strike forces of federal prosecutors and agents, along with state counterparts, specializing in health care investigations. They would receive about $500 to $900 per brace from Medicare and paid kickbacks of nearly $300 per brace, according to The Associated Press.
Additionally, if a beneficiary whose information was misused ever does need an orthopedic brace, he or she may encounter waiting periods from Medicare. "Medicare fraud is not a victimless crime".