3 Michigan doctors and nurse practitioner resolve Medicare fraud allegations
Federal prosecutors and law enforcement agents continue to show that they place allegations of Medicare fraud high on their list of priorities.
Fast as a click
The U.S. Attorney's office in the Western District of Michigan has announced the results of a Medicare fraud sting called "Operation Happy Clickers", which has resulted so far in civil suits against three Michigan doctors and a guilty plea by a nurse practitioner. The name of the operation refers to the speed at which the involved medical professionals clicked on and approved prescriptions with little or no review. The prescriptions at issue were for various medical equipment and genetic tests that were not actually medically necessary.
The US Attorney's Office said the actions resolved allegations of Medicare fraud that totaled $7.3 million.
Operation Happy Clickers follows nationwide arrests in 2019 and 2020 of what were called large-scale Medicare fraud schemes involving telemarketers, durable medical equipment supply company owners and cancer genetic testing labs.
How the alleged scheme worked
In the recent Michigan case, telemarketers (often in overseas call centers) contacted Medicare recipients to sell them medically unnecessary tests and devices. The marketers then allegedly paid healthcare professionals to sign device and test orders. Then the telemarketers allegedly sold the approved orders to companies that supply devices and labs that perform genetics testing.
According to federal prosecutors, the actions violated the federal Anti-Kickback Statute.
The nurse practitioner, from Ishpeming in the Upper Peninsula, pleaded guilty to a single count of making a false statement about healthcare matters. In the plea agreement, he admitted to signing orders for unnecessary devices and cancer genetic testing and claiming that he performed patient assessments and verified that the orders were medically necessary though he rarely reviewed the records.
He admitted Medicare paid out more than $5.7 million for the orders he’d approved.
He is scheduled to be sentenced in mid-September.
Civil suit settlements
The three physicians are from Petoskey, Royal Oak and formerly Portland, Michigan. They agreed to pay to settle the civil suits, in order, $301,140 and $42,000 and $28,545.
Medical professionals who are being investigated or who have been charged with healthcare fraud have the right to legal representation that can defend their freedom and interests.