On April 29, 2024 Manishkumar Patel was found guilty in connection with a $50 million healthcare fraud and kickback scheme involving the sale of fraudulent prescriptions for durable medical equipment. Déjà vu? Not really. The same DME fraud case that keeps getting recycled in the news? No. Does DME products ever get mentioned without fraud connected to it? Apparently, not. In the world of health care scams, durable medical equipment has long been considered treasure for fraud. Although durable medical equipment plays a critical role in the lives of many seniors, the frequency of fraud surrounding its sale has turned it into one of the most vilified programs in Medicare. Medicare will pay 80 percent of their cost if prescribed by a doctor. Fraudsters can’t lose. Taxpayers do though.
Between 2019 and 2022, Patel fraudulently sold prescriptions and doctors’ orders for durable medical equipment, another other supplies and tests, to DME suppliers, pharmacies, and laboratories. Patel obtained the prescription orders from call centers that called Medicare beneficiaries and asked them perfunctory questions designed to justify that an order would be reimbursed by Medicare. In what is commonly called in the fraud world as “doctor chasing”, Patel would send the orders to a doctor who would sign the scripts without seeing any patients. In some cases, the doctors claim they were unaware of what they were signing. That’s a fraudster passing the buck on to a fraudsters maneuver. Patel then sold the forged orders to Medicare Providers, who filled the orders, mailed millions of unneeded durable equipment, and billed Medicare.
To cover up the kickbacks from the Medicare Providers to Patel, and facilitate record keeping, sham contracts were created for generic marketing services at flat rates were generated for record keeping. That’s a quite a verbal agreement.
Excellent job by the Department of Health and Human Services with this case.
Today’s Fraud of The Day is based on article “Leader of $50 million healthcare fraud pleads guilty” published by Mid Hudson News on April 29, 2024.
A 44-year-old Pelham Manor man pled guilty in federal court in connection with a $50 million healthcare fraud and kickback scheme involving the sale of fraudulent prescriptions for durable medical equipment and other medical supplies to suppliers, pharmacies and laboratories that obtained payment for those prescriptions from Medicare.
It is alleged that between 2019 and 2022, Manishkumar Patel and a co-conspirator fraudulently sold prescriptions and doctors’ orders for durable medical equipment, pharmaceuticals, and laboratory tests to Medicare providers.
