Health Law update by Lamb McErlane attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

On March 8, 2024, Jean Wilson, N.P. pleaded guilty to her role in conspiracy to defraud Medicare. As an owner of two telemedicine companies (Choice Care LLC and Tele Medcare LLC) and two orthotic brace suppliers (Southeastern DME and Choice Care Medical), Wilson used the companies to recruit medical professionals who could then be bribed to sign prescriptions for Medicare beneficiaries for orthotic braces. Additionally, the professionals would prescribe medically unnecessary medications that were ineligible for Medicare reimbursement or not provided as represented.

Sometimes, Wilson paid providers only once they signed orthotic brace orders. If a provider signed the orthotic brace order, it was often based only on a brief telephonic interaction with the beneficiary, if at all. Wilson and her providers further kept false and misleading documentation in support of claims to Medicare.

During the conspiracy period, Wilson and her providers caused the submission of false and fraudulent claims to Medicare, Medicare sponsors, and Medicare Part D plans for over $136 million, with Medicare, Medicare sponsors, and Medicare Part D plans paying at least $66 million.

Wilson pleaded guilty to conspiracy to commit health care fraud and wire fraud, and agreed to pay over $66 million in restitution to Medicare and the IRS. Her sentencing is scheduled for July 18, 2024 with Wilson facing a maximum penalty of 20 years in prison.

If you have any questions regarding the submission of Medicare claims, or any other health law issues, please feel free to contact Bill Kalogredis, Esq. or Sonal Parekh, Esq.

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Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for over 45 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.