A former Georgia nurse practitioner, who with her husband owned two telemedicine and two durable medical equipment companies (DME), faces up to 20 years in prison for her role in a Medicare kickback conspiracy that bilked Medicare out of $136 million.
Earlier this month, Jean Wilson pleaded guilty to conspiracy to commit healthcare fraud and wire fraud. In addition to the prison sentence, she agreed to pay more than $66 million in restitution to Medicare and the IRS. Sentencing is set for July 18.
Husband and Wife Indicted in Illegal Medicare Kickback Scheme
According to court documents, Wilson and her husband Reinaldo Wilson owned telemedicine companies – Advantage Choice Care LLC, and Tele Medcare – and orthotic brace suppliers, Southeastern DME and Choice Care Medical.
She recruited and paid medical professionals kickbacks and bribes to sign prescriptions for Medicare patients for orthotic braces and prescription drugs that either were medically unnecessary, not eligible for Medicare reimbursement, or not provided.
Medical Professionals Falsified Medicare Claims
The medical professionals she recruited often signed the orthotic brace orders based on a brief phone call with the patient or in some cases no interaction at all. Wilson and the medical providers she retained frequently signed false and misleading documentation to support the Medicare claims.
The claims in this Medicare kickback scheme totaled $136 million of which $66 million was paid by Medicare. The claims were made from approximately March 2017 through April 2019.
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who receive treatment paid for by government healthcare programs and from entering into certain kinds of financial relationships.
Healthcare Fraud Losses Continue to Mount
According to the United States Sentencing Commission, in fiscal year 2022, there were 431 healthcare fraud offenders who accounted for 8.4 percent of all theft, property destruction, and fraud offenses. The number of healthcare fraud offenders has increased by 1.4% since fiscal year 2018. The median loss from these crimes is nearly $1.3 million.
The top five districts for healthcare fraud offenders in 2022 were: Southern District of Florida (105); Eastern District of Michigan (41); Central District of California (28); Southern District of Texas (21); and the Northern District of Texas (15). The average sentence for healthcare fraud offenders was 30 months.
The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to healthcare fraud are in the tens of billions of dollars each year. A conservative estimate is 3 percent of total healthcare expenditures, while some government and law enforcement agencies place the loss as high as 10 percent of our annual health outlay, which could mean more than $300 billion.
The Penalties Can Be Severe
Providers who engage in fraud and abuse are subject to sanctions under a number of federal and state laws. Penalties range from monetary fines and damages to prison time as well as exclusion from federal healthcare programs, such as Medicare, Medicaid and TRICARE, a healthcare program for those in the military and their family.
How Our Firm Can Help
The minute you become aware that you or your company are under investigation is when you should contact a qualified healthcare attorney who specializes in criminal healthcare fraud.
The Health Law Offices of Anthony C. Vitale has been representing clients under investigation for more than three decades. For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com
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