I know that I know that I shouldn’t be shocked.
At the end of April 2024, New Jersey physician, Adarsh Gupta, M.D., was convicted by a federal court jury of submitting over $5.4 million in fraudulent Medicare claims for orthotic braces ordered via a telemarketing scheme.
Court documents and evidence presented at trial showed that Gupta signed thousands of orthotic brace prescriptions for close to 3,000 Medicare beneficiaries.
His relationship with those patients? A brief, sometimes remarkably brief, telemedicine connection fostered by a telemarketing company which, in turn, convinced the Medicare beneficiaries to accept unnecessary braces.
Evidence proved that these meaningless encounters meant that Gupta couldn’t possibly have diagnosed the beneficiaries or determined that orthotic braces were necessary. Yet by signing prescriptions, Gupta falsely represented that the braces were medically necessary and that he diagnosed the beneficiaries, had a care plan for them, and recommended that they receive certain additional treatment.
Two examples are darkly humorous: In one instance, Gupta prescribed a back brace, shoulder brace, wrist brace, and knee brace for an undercover agent following a phone call that lasted just over a minute. In the other, he prescribed a knee brace for a beneficiary without legs – they had previously been amputated.
Telehealth can be used to vastly improve patients’ access to medical care. At the same time, it can be used to vastly improve criminals’ access to Medicare dollars. It shouldn’t be that difficult for physicians to assess the bona fides of their proposed participation in a telehealth “business model” when the ones doing the proposing are telemarketers.
As I’ve mentioned on the blog many times, physicians can never rely on telemarketers or pain cream producers or, in this instance, medical device makers, for an analysis of the legality of any business venture. In the best of worlds, they could be naïve idiots. In the worst of worlds, they are criminals. But in any world, they will not be doing your prison time, just their own.
The jury convicted Gupta of three counts of health care fraud and two counts of false statements relating to health care matters. He faces a maximum penalty of 10 years in prison on each of the health care fraud counts and five years in prison on each of the false statements relating to health care matters counts. He is due to be sentenced on October 8, 2024.
