The Setting: A quiet courtroom in the U.S. District Court for the Northern District of Texas.
The Key Players: David M. Young, M.D., Defendant. Assistant U.S. Attorneys Brynn Schiess and Ethan Womble, prosecuting. Brantley Starr, U.S. District Judge, on the bench.
Special Guest Star: Pamela Edwin, the former office manager of a now-defunct Florida telemedicine company Sunrise Medical, Inc.
All eyes were on Pamela Edwin as she took the stand in the trial of David M. Young, M.D., accused of participating in a scam involving $70 Million in fake Medicare claims for orthotic braces and genetic tests in concert with, among others, Steven Kahn, Sunrise Medical’s owner, and Matthew Harrington and Michael Speer, marketers and patient recruiters.
In testimony seemingly lifted from film noir, Ms. Edwin testified against Dr. Young, stating that “if I sent him 25 prescriptions, within 20 or 30 minutes, they were signed.” She explained that many of the prescriptions were “pre-filled” by Sunrise’s nonmedical employees, who were “hookers, drug addicts … and some regular people.”
On May 24, 2024, a federal court jury convicted Young, 61, of Fredericksburg, Texas, of one count of conspiracy to commit health care fraud and three counts of false statements relating to health care matters.
The jury found that Young had signed thousands of medical records and prescriptions for orthotic braces and genetic tests that fraudulently represented that the braces and tests were medically necessary and that he had diagnosed the beneficiaries, had a plan of care for them, and recommended that they receive additional treatment.
The fraud impacted over 13,000 Medicare beneficiaries as well as several undercover agents posing as beneficiaries. Many of the 13,000 “patients” were never seen, spoken with, or otherwise treated by Dr. Young.
In return for approximately $475,000 in ill-gotten gains, the fraudulent prescriptions were passed along to brace supply companies and labs which in turn billed Medicare more than $70 million.
Young’s real payoff is the up to 25 years in federal prison that he’s now facing, with sentencing to take place at a later date.
Health care fraud is far from harmless. Fraudulent activities drain billions from health care programs like Medicare and Medicaid, leading to higher taxes and less money for other important services. The fraud often results in patients receiving unnecessary treatments or tests, which can cause real harm and stress. Health care fraud breaks the trust patients place in them, making people more skeptical about the care they receive.
And, as Dr. Young will likely soon attest, those convicted face long prison sentences, potentially hefty fines, and ruined professional reputations.
Although health care fraud doesn’t require the involvement of telemedicine, with advances in telemedicine come “advances” in criminal schemes.
It’s rare that a physician is the criminal mastermind. Often, they’re caught up in the real mastermind’s web. But that doesn’t make the physician a victim; it makes him or her a co-conspirator.
In closing, here are some takeaways for you, yes you, to consider:
- Any deal must be structured in compliance with the federal Anti-Kickback Statute, Stark, and various state law counterparts and other restrictions.
- Money, big money, is tempting. I know because I’ve counseled many clients in connection with telemedicine “ventures” paying what they must have thought was money from heaven.
- Yes, telemedicine has many valid applications. Violation of the AKS and committing fraud are not among them.
- And, the money’s not from heaven. It’s from hell.
Let’s talk before you consider any telehealth or telemedicine arrangement.
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