Unfortunately, scammers have figured out that Medicare will pay for Durable Medical Equipment (DNE). For the U.S citizen, DNE’s are orthopedic supplies, typically braces and supports for the arms, ankles, elbows, and back that become necessary at one point or another in long term care at home. For the fraudster, it’s an opportunity. It’s easy to steal from the health-care programs because there aren’t enough agents to keep up with the various schemes. Estimated annual fraud for Medicare is $100 billion which included millions of fraudulent DME claims.
Medicare pays for DME’s when prescribed by a doctor prescribes. Doctor Adarsh Gupta signed thousands of prescriptions for orthotic braces for over 2,900 Medicare beneficiaries that were provided by telemarketers who had convinced the beneficiaries to accept unnecessary braces. Gupta did speak to the beneficiaries over the phone before prescribing the DME for them, briefly. Long enough to sign a prescription but not long enough to diagnose the patient accurately.
For instance, Gupta prescribed a back brace, shoulder brace, wrist brace, and knee brace for an undercover agent after speaking with the agent for just over a minute on the telephone. In another instance, Gupta prescribed a knee brace for a Medicare beneficiary whose legs had previously been amputated. No need to be accurate with the diagnosis when the intent is to defraud the Medicare program. Nevertheless, Gupta’s false prescriptions were used by brace supply companies to bill Medicare more than $5.4 million.
On April 25, 2024, the jury convicted Gupta of three counts of health care fraud and two counts of false statements relating to health care matters.
Excellent job by the Department of Health and Human Services, working very hard with little resource to do it.
Today’s Fraud of The Day is based on article “NJ: Doctor Convicted for $5.4M Medicare Fraud Scheme” published by The National Association of Drug Diversion Investigators on April 26, 2024.
A federal jury convicted a New Jersey doctor today for causing the submission of over $5.4 million in fraudulent claims to Medicare for orthotic braces ordered through a telemarketing scheme.
According to court documents and evidence presented at trial, Adarsh Gupta, M.D., 51, of Sewell, signed thousands of prescriptions for orthotic braces for over 2,900 Medicare beneficiaries whom he was connected with by telemarketers who convinced the beneficiaries to accept unnecessary braces. After briefly speaking to the beneficiaries over the telephone, Gupta prescribed orthotic braces for them.
