Dialing for Medicare Dollars

Silhouette of lonely elderly man walking with a walker near the window at home

A New Jersey physician pleaded guilty in September 2019 in one of the nation’s largest healthcare and Medicare fraud cases to date. Joseph DeCorso admitted that he worked for two so-called telemedicine companies, writing orders for medically unnecessary orthotic braces for Medicare beneficiaries.

The beneficiaries were lured into the scheme by an international telemarketing network promising them free or low-cost braces. DeCorso admitted that, in less than two years, his part in the scheme resulted in a $13 million intended loss to Medicare. (That’s a lot of shady phone work!) As part of his plea agreement, DeCorso agreed to pay over $7 million in restitution to the United States and to forfeit assets and property traceable to proceeds from the fraud.

DeCorso wrote brace orders stating he had “discussions” or “conversations” with beneficiaries or conducted diagnostic testing for them. But DeCorso never spoke to beneficiaries or conducted any diagnostic testing for the braces. (It just goes to show that if you’re going to commit fraud, it only makes sense to lie about it.) The telemedicine companies sold the prescriptions to medical equipment companies that filled the orders, billed Medicare, and paid kickbacks to physicians such as DeCorso.

As egregious as DeCorso’s conduct was, his escapades are just the tip of this criminal iceberg. With his 23 co-defendants, the New Jersey scammer contributed to a whopping $1.2B Medicare fraud scheme.

Today’s Fraud of the Day comes from a United States Department of Justice news release, “New Jersey Doctor Pleads Guilty to $13 Million Conspiracy to Defraud Medicare with Telemedicine Orders of Orthotic Braces,” published Sep. 12, 2019.

A Toms River, New Jersey physician pleaded guilty today for his role in a $13 million health care fraud scheme, which previously resulted in charges in April 2019 against 23 other defendants in one of the largest health care fraud cases investigated by the FBI and the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG) and prosecuted by the Department of Justice.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Craig Carpenito of the District of New Jersey, Assistant Director Robert Johnson of the FBI’s Criminal Investigative Division, Deputy Inspector General for Investigations Gary Cantrell of HHS-OIG and Deputy Administrator and Director Alec Alexander of the Centers for Medicare & Medicaid Services, Center for Program Integrity (CMS/CPI) made the announcement.

Additional information is available in a Becker’s Hospital Review article, “New Jersey physician charged in $1.2B fraud scheme pleads guilty,” published Sep. 13, 2019.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.