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Doctor Fraud

Healthcare-Medicare-10
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

According to Health Affairs, fraud entails “illegal activities in which someone gets something of value without having to pay for it or earn it.” It also is achieved by people who have no care for how their actions impact others. There is no better example than in the actions of Dr. Gautam Jayaswal. While diagnosing and treating patients virtually, this telemedicine doctor ordered millions of dollars’ worth of unnecessary and expensive genetic tests and orthotic braces. He had little care for how his actions impacted his patients or the U.S. taxpayer. And both were hurt from his actions.

Medically licensed since 1986, Jayaswal mostly worked as an emergency room physician. Starting in 2017 and continuing into 2021, contracted as a telemedicine doctor with several companies. During that period, Jayaswal fraudulently ordered one or more orthotic braces for 1,433 patients. The companies used those fraudulent orders to defraud Medicare out of approximately $1.36 million. Between June 2018 and September 2021, Jayaswal signed orders for medically unnecessary genetic tests. Medicare Part B paid about $14.7 million for the 2,061 patients for whom Jayaswal was listed as the ordering physicians.  That is a called getting something of value without earning it! Sitting on a Zoom call wearing the white coat and bunny slippers while making up diagnoses is certainly easier than midnight shift at the emergency room. But easy money isn’t always the right way and eventually, this fraudster was questioned.

On May 9, 2023, Jayaswal pleaded guilty in the U.S. District Court in St. Louis to conspiracy to commit health care fraud. The 64-year-old man faces up to five years in prison and a $250,000 fine in addition to full restitution.

Shout out to the Department of HHS in this investigation.

Today’s Fraud Of The Day is based on article “Kansas Physician Admits to Role in Telemedicine Fraud Scheme” published by U.S. News and World Report on May 9, 2023

A doctor from Kansas admitted Tuesday to a role in a telemedicine fraud scheme for unnecessarily ordering genetic testing and orthotic braces, defrauding Medicare of about $16 million.

Gautam Jayaswal, 64, of Overland Park, Kansas, pleaded guilty in U.S. District Court in St. Louis to one count of conspiracy to commit health care fraud. He could face up to five years in prison and must repay the money.

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