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Fast Track To Fraud

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Jean Wilson was more than a licensed nurse practitioner. She was a business woman. Wilson owned two telemedicine companies, Advantage Choice CareCare and Tele Medcare. This may be a bold statement, but is there ever a telemedicine company without fraud? There is no data analysis behind this! But it sometimes feels that ownership of the telemedicine company is a fast track to fraud. To compound this implication, Wilson also owned two orthotic brace suppliers, Southeastern DME and Choice Care Medical. Orthotic brace supplier combined with the ownership of a telemedicine company, almost guarantees at least the very opportunity to consider fraud! Which Wilson did consider for a quick minute. And then she did it.

Wilson, through these companies, recruited medical providers who were bribed to sign prescriptions for Medicare beneficiaries to fraudulently receive orthotic braces and prescription drugs that were medically unnecessary and ineligible for Medicare reimbursement. Wilson made a practice of only paying providers when they signed orthotic brace orders. A big money maker in the Medicare industry. An incentive plan for fraud. The medical providers Wilson recruited would often sign the orthotic brace orders based solely on a brief telephonic interaction with the beneficiary (Hi. Thank you for calling. Have a good day.).

Sometimes there was no interaction at all. Wilson and the medical providers she retained would then sign false and misleading documentation to support her claims to Medicare. Who always paid! During the conspiracy, Wilson submitted approximately $136 million for claims that did not qualify for reimbursement. Wilson received at least $66 million from those fraudulent claims.

On March 11, 2024, Wilson pleaded guilty to conspiracy to commit health care fraud and wire fraud. part of her plea, she has agreed to pay over $66 million in restitution to Medicare and the IRS. Excellent job by the Department of Health and Human Services in this investigation.

Today’s Fraud of The Day is based on article “Telemedicine Business Owner Faces 20 Years For $136m Fraud” published by Inforsecurity Magazine on March 11, 2024.

A nurse practitioner has pleaded guilty to her role in a massive $136m conspiracy to defraud the US government’s Medicare program.

Jean Wilson, 52, of Richmond Hill, Georgia, was a licensed nurse practitioner in New Jersey and owned two telemedicine companies – Advantage Choice Care and Tele Medcare – as well as two orthotic brace companies.

She recruited medical professionals to work for these companies and bribed them to sign prescriptions for Medicare beneficiaries for orthotic braces and drugs. These prescriptions were either medically unnecessary, ineligible for Medicare reimbursement or not provided as represented, according to the Department of Justice (DoJ).

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