ARTICLE: Two Montanans accused in telemedicine scheme to defraud Medicare

“These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain.”

Two Montanans accused in telemedicine scheme to defraud Medicare

From Staff Reports, Great Falls Tribune 

Two Montana nurse practitioners are accused of participating in a scheme to defraud Medicare of almost $10 million and are part of a nationwide sweep that includes hundreds of defendants and billions of dollars, officials said Wednesday.

Mark Allen Hill, 54, of Edenburg, N.D., and whose address of record for participation in the Medicare program was Cut Bank, and Janae Nichole Harper, 33, of Kalispell and formerly of Billings, were charged with conspiracy to commit health care fraud, officials said.

Each defendant is accused of receiving money to sign unnecessary brace orders, often without ever talking to the Medicare beneficiary to determine whether the braces were medically necessary, the Montana U.S. Attorney’s office said.

The indictment alleges Hill signed fraudulent medical orders for braces resulting in more than $10 million in claims to Medicare, of which the government paid more than $5 million. The indictment charging Harper alleges she signed fraudulent medical orders for braces resulting in more than $8 million in claims to Medicare, of which the government paid more than $4 million, officials said in a news release.

Hill and Harper face a maximum 10 years in prison and a $250,000 fine.

Arraignments for both are set for Oct. 27 in Great Falls before U.S. Magistrate Judge John T. Johnston. The cases are being prosecuted by Assistant U.S. Attorney Michael A. Kakuk and Robyn N. Pullio, trial attorney.

U.S. Attorney’s Office for Montana and the U.S. Department of Justice on Wednesday announced “historic national health care fraud and opioid enforcement actions” that involved 345 charged defendants across 51 federal districts.

This includes more than 100 doctors, nurses and other licensed medical professionals, Acting Assistant Attorney General Brian C. Rabbitt said.

These defendants have been charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, including more than $4.5 billion connected to telemedicine, more than $845 million connected to substance abuse treatment facilities, or “sober homes,” and more than $806 million connected to other health care fraud and illegal opioid distribution schemes across the country, officials said.

“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in health care fraud across the country,” Rabbitt said.  “These cases hold accountable those medical professionals and others who have exploited health care benefit programs and patients for personal gain.”

The largest amount of alleged fraud loss charged in connection with the cases – $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts – relates to schemes involving telemedicine:  the use of telecommunications to provide health care services remotely. 

 According to court documents, certain defendant telemedicine executives allegedly paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and other diagnostic testing, and pain medications, either without any patient interaction or with only a brief telephonic conversation with patients they had never met or seen.

Durable medical equipment companies, genetic testing laboratories, and pharmacies then purchased those orders in exchange for illegal kickbacks and bribes and submitted false and fraudulent claims to Medicare and other government insurers.

Read More: https://www.greatfallstribune.com/story/news/2020/09/30/montana-nurse-practioners-accused-telemedicine-medicare-fraud-scheme/5873567002/