Federal prosecutors arrested the owners of two Georgia-based telemedicine companies on Feb. 4th on charges of conspiracy ranging from fraud to money laundering. Reinaldo Wilson, 51, and his wife, Jean Wilson, 49, allegedly led a scheme to receive kickbacks and bribes for ordering orthodontic braces through Medicare for people who didn’t need them. The indictment indicates the plan operated between March 2017 and April 2019.

The plan involved the couple recruiting providers to order the medically unnecessary braces and then paying those providers with illegal kickbacks and bribes.  The fraudulent scheme resulted in over $56 million in false claims to Medicare, with Medicare paying the brace suppliers in excess of $28 million.

The Department of Justice named Advantage Choice Care LLC (ACC) and Tele Medcare LLC (Tele Medcare) as the companies involved in the plan. Both are owned by the Wilsons and had locations in Bayonne, N.J.; Boca Raton, Fla.; and Richmond Hill, GA.

The specific charges were outlined as one count of conspiracy to defraud the U.S. and to pay and receive healthcare kickbacks, one count of conspiracy to commit healthcare fraud and wire fraud, three counts of receiving healthcare kickbacks and one count of conspiracy to commit money laundering. The money laundering charge alleges that the couple agreed to engage in transactions of property in excess of $10,000 obtained through criminal activity.

The indictment states, “In order to obtain the orders that were transmitted in exchange for kickbacks and bribes, Reinaldo Wilson and Jean Wilson, through ACC and Tele Medcare, recruited and hired health care providers to order braces for Medicare beneficiaries.”

In 2018, the Medicaid Fraud Control Units (MFCUs or Units) of the Department of Health and Human Services Office of the Inspector General recovered over $859 million from both criminal and civil cases. The Units are responsible for investigating and prosecuting Medicaid provider fraud and patient abuse or neglect.

The National Health Care Anti-Fraud Association, a private-public partnership committed to fighting health care fraud, reports that conservative estimates place health care fraud at approximately $68 billion each year. That figure is about 3 percent of all health care spending. Other estimates are as high as $230 billion, or 10 percent of all spending. The Mission of the Association is to “protect and serve the public interest by increasing awareness and improving the detection, investigation, civil and criminal prosecution, and prevention of health care fraud and abuse.”

If you have been a victim of Medicare fraud or suspect such fraud, Contact Brian Silber, P.A. to set up a free initial consultation.