A Michigan nurse practitioner pled guilty and three doctors settled civil suits as part of a Medicare fraud sting dubbed Operation Happy Clickers. The medical professionals illegally signed off on orders for unnecessary medical braces and cancer genetic testing promoted by telemarketers.
The series of criminal and civil actions were part of an ongoing national investigation to resolve alleged Medicare fraud losses totaling over $7.3 million to date, according to the US Attorney's Office in Michigan.
The "Happy Clickers" legal actions follow nationwide takedowns in 2019 and 2020 of purported marketers, owners of durable medical equipment supply companies, and cancer genetic testing laboratories who conducted large-scale schemes designed to defraud the Medicare program.
With telemedicine on the rise during the pandemic and more Medicare patients approved to use it, the latest takedowns are in line with other large federal investigations of fraud involving both telehealth and Medicare abuse.
In this case, the marketers contacted Medicare beneficiaries, often from overseas call centers, and solicited them for the medically unnecessary devices and testing. The marketers also paid the medical professionals to purportedly review and sign orders under the guise of telemedicine and then sold those signed orders to the owners of the device supply companies and laboratories in violation of the federal anti-kickback statute.
Richard Laksonen, NP, from Ishpeming, Michigan, pled guilty to one count of making a false statement related to healthcare matters. As part of his plea agreement, Laksonen admitted that he signed orders for medical braces and cancer genetic testing, claimed that he performed assessments, and verified that the orders were reasonably and medically necessary, although he typically executed the orders without reviewing the records, the US Department of Justice (DOJ) reported.
For example, Laksonen admitted that during a 1-week period, he signed about 335 single-patient files, many of which involved multiple types of braces. He spent on average of 18 seconds from the time he opened the record to the time he executed it. He continued to approve these orders after an investigator for a health insurer warned him that the patient referrals were the result of aggressive telemarketing, the federal release stated.
As part of his plea agreement, Laksonen admitted that Medicare paid over $5.7 million for the orders he approved and signed. Laksonen is scheduled to be sentenced November 15.
Infectious disease specialist Hugh G. Deery, II, MD, of Petoskey, Michigan; internist Mosab Deen, DO, of Royal Oak, Michigan; and family physician Colleen Browne, DO, formerly of Portland, Michigan, settled civil charges for alleged violations of the False Claims Act. They were charged with approving orders for medically unnecessary braces and cancer genetic testing despite many red flags that these items and services were illegal, the federal press release stated.
Deery agreed to pay $301,140; Browne, $42,000; and Deen $28,545. Browne's settlement also resolved allegations that she ordered medically unnecessary cancer genetic testing for Medicare beneficiaries for screening purposes. Medicare typically doesn't cover genetic testing solely for the purpose of screening for cancer, according to federal officials.
Operation Happy Clickers is an ongoing initiative by the US Department of Health and Human Services, the Federal Bureau of Investigation, and the US Attorney's Office.
In recent years, there have been several large investigations of similar fraud schemes. In September 2020, an investigation referred to as Operation Rubber Stamp resulted in what was reported to be the DOJ's largest series of healthcare fraud prosecutions. The cases involved more than $6 billion in fraudulent claims, $4.5 billion of which was related to telemedicine.
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Cite this: Nurse, Three Doctors Nabbed in $7.3M Medicare Telemarketing Fraud Sting - Medscape - Aug 30, 2021.