Tag: Braces
Nurse charged with brace schemeÂ
October 10, 2023HME News Staff
BOSTON – A Virginia-based nurse practitioner has been charged with one count of conspiracy to commit health care fraud in connection with a $7.8 million telemedicine fraud scheme involving medically unnecessary DME, including back and knee braces. According to charging documents, between December 2018 and April 2020, Daphne Jenkins worked with a telemedicine company to sign orders for medically unnecessary DME. She allegedly signed orders that were pre-populated based on telemarketing calls...
Woman charged in $17.3M brace and CGM schemeÂ
December 20, 2022HME News Staff
NEW YORK – Alexandra Stchaslivteseva, 52, of New York has been arrested for allegedly offering and paying illegal health care kickbacks and money laundering, resulting in Medicare paying more than $17.3 million in false claims. She allegedly offered and paid kickbacks and bribes to several purported telemedicine companies and marketing companies in exchange for completed doctor orders of medically unnecessary orthotic braces and continuous glucose monitors for Medicare beneficiaries. Stchastlivtseva...
Two sentenced for orthotics-related fraudÂ
December 12, 2022HME News Staff
TAMPA and RALEIGH, N.C. – Ruth Bianca Fernandez has been sentenced to three years in prison for her role in a conspiracy to commit health care fraud and for making a false statement in a matter involving a federal health care benefit program. Government officials say Fernandez, who worked directly under Patsy Truglia, who has already been sentenced, and other conspirators generated medically unnecessary physician orders via their telemarketing operation for certain orthotic devices—knee...
Jury convicts DME owners in brace scheme
July 13, 2021HME News Staff
DALLAS – A federal jury has convicted Dallas area owners and operators of two DME companies of one count of conspiracy to defraud the United states and to pay and receive health care kickbacks, and one count of conspiracy to commit money laundering. According to evidence presented at trial, Leah Hagan and Michael Hagen, the owners and operators of Metro DME Supply and Ortho Pain Solutions, paid a fixed rate per DME item in exchange for prescriptions and paperwork completed by telemedicine doctors...
Jury charges four for scheme involving telehealth, braces
June 1, 2021HME News Staff
GROVE CITY, Ohio – A federal grand jury has returned a 24-count indictment charging four individuals for their roles in an alleged fraud scheme that led to more than $20 million in false claims to the Medicare program, according to the U.S. Attorney’s Office for the Northern District of Ohio. Two defendants, Elizabeth Baljak and Megan Ilg are accused of signing prescriptions for medical braces regardless of medical necessity, without a physical exam and frequently without any contact...
Feds charge five in massive fraud scheme
April 29, 2021HME News Staff
NEWARK, N.J. – Five individuals have been charged and two others have pleaded guilty for their roles in a $93 million kickback fraud scheme involving DME and genetic cancer screening, according to the U.S. Attorney’s Office for the District of New Jersey. Thomas Farese, Pat Truglia, Domenic Gatto, Nicholas Defonte and Christopher Cirri are each charged by complaint with conspiracy to commit health care fraud; while Brian Herbstman has pleaded guilty to conspiracy to commit health...
They say crime doesn't pay. In this case, it appears to have bought a yacht.
January 25, 2021Theresa Flaherty, Managing Editor
I received a press release last week from the DOJ about the latest news in Medicare fraud involving, what else, braces!
Juan Camilo Perez Buitrago and two of his employees submitted more than $109 million in false claims for arm, back, knee and shoulder braces. (nothing to see here).
But it’s the details that really made me say, WTF? You see, as part of his scheme, Buitrago had the employees, Jessica Jones and Elizabeth Putulin, list his wife, mother and yacht captain as directors for...
In brief: Bid amounts for braces, changes for CGMs and external pumps, provider reactions
October 30, 2020HME News Staff
WASHINGTON – CMS on Oct. 27 announced Round 2021 single payment amounts for off-the-shelf back braces and knee braces.
The agency has made contract offers for back and knee braces in 127 CBAs, a move that it expects to save $600 million for the Medicare program and beneficiaries over the three-year contract period.
CMS is not making offers for back and knee braces in certain CBAs where savings would not be achieved. Payment in those areas will be based on adjusted fee schedule...
CGS announces reviews for back braces, test strips
August 13, 2020HME News Staff
ATLANTA - CGS has announced that the Jurisdiction B medical review department will begin complex post-pay service-specific reviews on back braces and test strips, according to the van Halem Group. Both reviews are the result of data analysis that indicates the allowed dollars for the two codes in Jurisdiction B are significantly above expected amounts. Each code also ranks high in the CERT Errors Top 15, with L0650 ranking No. 6 and A4253 No. 11, according to the van Halem Group. Based on earlier...
O&P stakeholders take next steps to preserve access
April 26, 2019Theresa Flaherty, Managing Editor
WASHINGTON - O&P stakeholders plan to use a recent massive fraud takedown involving medically unnecessary knee and back braces to advance upcoming legislation.The American Orthotic & Prosthetic Association has been trying to get legislation passed for several years that would curb fraud and abuse, and improve access to clinically appropriate care for beneficiaries.“It's great to see this first wave of charges,” said Todd Eagen, president of the Orthotic Prosthetic Group of America. “I...