While enforcement actions announced last week again saw few lab-related cases, they did reflect the continued trend of schemes involving telemedicine companies or doctors. Of three key healthcare industry-related actions, two involved telemedicine. The lone lab-testing related scheme involved genetic testing, which, along with telemedicine, has become a target for enforcement agencies in recent years.
| Date Action Announced | Defendant(s) | Allegations/Charges/Convictions | Result |
| Jan. 25 | · Henry Barton · David Tsui · Jeffrey Hoffman · Steve Lowell · Christina Anderson · Kathryn VanRavenstein · John Hynes | Seven people were sentenced for their roles in a kickback scheme involving DME, marketing, and dropship companies, as well as call centers and telemedicine doctors. Kickbacks were paid for patient information and signed prescriptions for DME from the telemedicine doctors, who had no contact with the supposed patients. The DME companies would then bill federal health insurance programs for the orders. | The seven individuals received varying sentences from three to five years of probation, to 12 to 24 months in prison, along with having to pay restitution amounts ranging from $14,863.00 to $1,850,000.00.1 |
| Jan. 26 | · Scott Wohrman · David Heneghan | The two owners of supposed lab marketing services company American Health Screening (AHS) were each charged with one count of conspiracy to violate the Federal Anti-Kickback Statute and one count of conspiracy to commit healthcare fraud for their involvement in a scheme where they were paid kickbacks in exchange for DME and genetic testing orders, resulting in a loss of $565,629 for Medicare. | Both Wohrman and Heneghan pled guilty to the charges and are to be sentenced in September 2023. They each face up to 10 years in prison on the healthcare fraud count and up to five years for the Anti-Kickback Statute charge, as well as fines of up to “$250,000 or twice the gross gain or loss from the offense” for each offense.2 |
| Jan. 30 | · Dean Zusmer, chiropractor · Lawrence Alexander, MD, orthopedic surgeon | Two doctors were convicted of their roles in a $31 million Medicare fraud scheme in which Zusmer, owner of one of 4 DME companies involved, and others paid kickbacks to marketers who then obtained referrals and signed doctor’s orders for medically unnecessary DME via call centers and telemedicine companies. The DME was then billed to Medicare. Alexander also owned one of the DME companies involved in the conspiracy. | · Zusmer was convicted of 5 counts relating to the scheme. He faces up to 10 years in prison for each of three of the counts · Alexander was convicted of 1 count related to the scheme and faces up to five years in prison · Both are set to be sentenced in April 2023.3 |
References:
- https://www.justice.gov/usao-sc/pr/seven-sentenced-kickback-conspiracy-defraud-federal-health-insurance-programs
- https://www.justice.gov/usao-nj/pr/two-individuals-admit-participating-health-care-fraud-and-kickback-schemes
- https://www.justice.gov/opa/pr/two-florida-doctors-convicted-31-million-medicare-fraud-scheme