Medical practitioners in Michigan are held responsible for their role in Medicare fraud scheme.
On Aug. 24, U.S. Attorney Andrew B. Birge announced criminal and civil enforcement actions against four Michigan medical practitioners for their role in perpetuating a telemedicine scheme to defraud Medicare. The practitioners signed off on illegitimate orders for medical braces and cancer genetic testing promoted by telemarketers. The ongoing investigation was dubbed Operation “Happy Clickers” to reflect the habit of medical personnel “clicking through” their approvals with little or no review. The operation is an ongoing initiative by the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), the FBI, and the U.S. Attorney’s Office for the Western District of Michigan.
The recent enforcement actions, which help to resolve alleged fraud losses topping $7.3 million, follow on the heels of more than two years of nationwide takedowns of so-called marketers and owners of durable medical equipment (DME) supply companies and cancer genetic testing laboratories who conducted large-scale fraud schemes designed to defraud Medicare.
The Michigan investigation revealed that marketers called Medicare beneficiaries, often from overseas call centers, to solicit them for braces or cancer genetic testing screening, both of which were medically unnecessary. The marketers then paid medical practitioners to review and sign their orders under the guise of telemedicine and subsequently sold those signed orders to owners of DME supply companies and laboratories in violation of the federal anti-kickback statute.
It became clear to investigators that if the medical practitioners had taken the time to listen to the recorded phone calls, they would have known that the calls were from telemarketers and not medical professionals. “Given that their approval and signatures are necessary for Medicare to pay for these braces and testing, medical practitioners are the professional backstop against these fraud schemes,” said U.S Attorney Birge. “And when medical practitioners ignore their professional responsibilities, facilitating these fraud schemes in our district, they will be held accountable.” The orders the physicians signed resulted in hundreds of thousands of dollars paid by Medicare for medically unnecessary braces, which beneficiaries often did not want or use, and medically unnecessary cancer screening, which was not needed. Generally, Medicare does not cover genetic testing solely for the purpose of screening for cancer.
The resolutions U.S. Attorney Birge announced involve four of the Michigan practitioners who approved and signed these orders on behalf of the marketers:
Richard Laksonen, NP, a nurse practitioner from Ishpeming, MI, pleaded guilty on Aug. 6, 2021, to one count of making a false statement relating to healthcare matters. Mr. Laksonen admitted that he signed orders for medical braces and cancer genetic testing, attesting that he had performed the assessments and verifying that the orders were reasonably and medically necessary, when, in fact, he typically executed the orders without reviewing the records. In a single one-week period, he signed approximately 335 separate patient files. Mr. Laksonen continued to approve these orders, even after an investigator for a health insurer warned him that the patient referrals were the result of aggressive telemarketing. The investigation further established that many of these braces and tests were not medically necessary. As part of his plea agreement, Mr. Laksonen admitted that Medicare paid over $5.7 million for the orders he approved and signed.
Hugh G. Deery II, MD, of Petoskey, MI, Colleen Browne, DO, formerly of Portland, MI, and Mosab Deen, DO, of Royal Oak, MI, resolved civil liability for alleged violations of the False Claims Act by entering into civil settlements with the United States. These physicians approved orders for medically unnecessary braces and cancer genetic testing despite many red flags that these items and services were illegitimate. For example, there were often discrepancies between the brace orders and “examination” notes that the physicians signed and the recorded phone calls between the overseas call centers and the Medicare beneficiaries. Additionally, marketers often suggested the physicians sign multiple brace orders for each beneficiary, and the physicians were pressured not to deny claims.
To resolve their individual liability, Dr. Deery has agreed to pay $301,140, Dr. Browne has agreed to pay $42,000, and Dr. Deen has agreed to pay $28,545. Dr. Browne’s settlement agreement also resolved allegations that she ordered medically unnecessary cancer genetic testing for Medicare beneficiaries for cancer screening purposes. The Court will sentence Mr. Laksonen in November.
“The ordering of medically unnecessary services resulting from purported telemedicine visits to Medicare is blatant fraud,” said Lamont Pugh III, Special Agent in Charge, HHS-OIG – Chicago Region. “The OIG will continue to work with our law enforcement partners and federal prosecutors to identify and hold accountable those individuals who choose to execute healthcare fraud schemes, and the practitioners who legitimize these schemes, and waste vital taxpayer dollars.” Timothy Waters, Special Agent in Charge of the FBI’s Detroit Field Office went on to say, “As medical professionals, these defendants had an obligation to conduct a good faith review of the devices and medical tests being ordered on behalf of Medicare patients.”
Individuals, including medical professionals, who are aware of past or ongoing conduct involving solicitation and fraudulent approval of medical braces and cancer genetic testing through purported telemedicine services can call the U.S. Attorney’s Office Healthcare Fraud Investigator at 616-808-7572 or submit an online complaint to the HHS-OIG Hotline: https://oig.hhs.gov/fraud/report-fraud