Operation Brace Yourself Scores Again: $27 Million Fraud Scheme Ends in 12 Years’ Sentence for Medical Equipment Company Owners
For hiding bribes and kickbacks as “marketing” and “business process outsourcing” expenses and billing more than $59 million in false claims to Medicare, two durable medical equipment (DME) company owners were recently sentenced to over 12 years in prison.
These fraudsters were exposed as part of Operation Brace Yourself, a federal law enforcement action led by the Health Care Fraud Unit of the United States Department of Justice’s Criminal Division’s Fraud Section, which is an ongoing effort to track down DME fraud.
According to court records, the owners of Metro DME Supply LLC and Ortho Pain Solutions LLC conspired to obtain signed doctor’s orders for medically unnecessary DME. Over a three-year period, they “paid kickbacks and bribes to their co-conspirator’s call center in the Philippines in exchange for signed doctors’ orders for DME that were used to submit false claims in excess of $59 million to Medicare,” from which the DME company owners profited to the tune of $27 million. They concealed their profits by hiding it in overseas accounts and foreign real estate and concealed the kickbacks by claiming those payments were for marketing and outsourcing expenses. As the DME claims submitted to Medicare were for medically unnecessary DME, the company owners sometimes persuaded Medicare beneficiaries to accept unnecessary equipment by giving them gift cards as well.
For conspiracy to defraud the United States, pay and receive health care kickbacks, and launder money, the DME company owners were sentenced to 151 months in prison and must pay $27 million in restitution.
DME includes daily use items such as blood testing strips for diabetics, as well as wheelchairs, oxygen equipment, and crutches. Scheming to send medically unnecessary durable medical equipment to people who do not need it—and charging the government for said equipment—jeopardizes the availability and affordability of DME for beneficiaries of other government-funded healthcare programs.
Whistleblowers can help with Operation Brace Yourself. Whistleblowers who report Medicare fraud may receive 15-25% of the government’s recovery.