GRAND RAPIDS, Mich. (WJMN) – U.S. Attorney Andrew B. Birge announced several criminal and civil enforcement actions taken as part of a joint-agency healthcare fraud operation in the Western District of Michigan.
Medical practitioners were investigated for signing off on illegitimate orders for medical braces and cancer genetic testing promoted by telemarketers. The investigation is dubbed Operation “Happy Clickers” to reflect a habit of the practitioners approving orders with little to no review. It will resolve alleged fraud losses to date to the Medicare Program of over $7.3 million.
The actions follow 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 the Medicare Program. Marketers called Medicare beneficiaries and solicited them for medically unnecessary braces and cancer genetic testing for screening purposes. Typically working through locum tenens companies the marketers would pay medical practitioners to purportedly review and sign the orders under the guise of telemedicine and sell the signed orders to the owners to DME supply companies and laboratories in violation of the federal anti-kickback statute.
U.S. Attorney Birge announced that four Michigan practitioners were involved.
Richard Laksonen, N.P. – plead guilty on August 6 to one count of making a false statement relating to health care matters. Laksonen admitted to signing orders for medical braces and cancer genetic testing attesting that he had performed the assessments and verified the orders were reasonably and medically necessary. In fact, he typically executed the orders without reviewing the records. Laksonen admitted to signing approzimately 335 separate single-patient files in one week. Several of the files contained multiple types of braces and he spent on average 18 seconds from he time he opened the record to the time he executed it. Even after being warned by an investigator for a helath insurer about the referalls being a part of aggressive telemarketing. As part of the plea agreement, Laksonen admitted that Medicare paid over $5.7 million for the orders he approved and signed. He will be sentenced on November 15.
The other three practitioners entered into civil settlements with the United States. They approved orders for medically unnecessary braces and cancer genetic testing despite red flags that the items and services were illegitimate. 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 Medicare beneficiaries. Marketers often suggested physicians sign multiple brace orders for each beneficiary and pressured physicians to not deny claims.
Hugh G. Deery II M.D. of Petoskey, Mi will pay $301,140 and Mosab Deen, D.O., of Royal Oak, MI will pay $28,545. Colleen Browne, D.O., formerly of Portland, MI, will pay $42,000 and also resolved allegations that she ordered medically unnecessary cancer genetic testing for Medicare beneficiaries for cancer screening. Generally, Medicare does not cover genetic testing solely for the purpose of screening for cancer.
Medicare beneficiaries that were targeted by the scheme complained of being “bombarded” by overseas telemarketing calls offering “free” braces.” The U.S. Department of Justice says that if the medical practitioners had listened to the phone calls they would have known that they were run by telemarketers. The orders physicians signed resulted in hundreds of thousands of dollars paid by Medicare for medically unnecessary braces, which beneficiaries often did not want or use.
“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 ordering of medically unnecessary services resulting from purported telemedicine visits to
Medicare is blatant fraud,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of
Health & Human Services, Office of Inspector General – 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.”
“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,” said Timothy Waters,
Special Agent in Charge of the FBI’s Detroit Field Office. “Their failure to do so contributes to the
billions of dollars of fraud losses Medicare suffers annually. Collaborative efforts like this one,
demonstrate the FBI and our partners resolve to hold accountable those seeking to defraud the
Operation “Happy Clickers” is an ongoing initiative by HHS-OIG, the FBI and the U.S. Attorney’s office for the Western District of Michigan. Attorney Raymond E. Beckering III is
overseeing and prosecuting the criminal investigation, and Assistant U.S. Attorney Andrew J. Hull
is representing the United States in the parallel civil investigations.
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/
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