The owner of two telemedicine The court sentenced companies today to 7 years in prison and ordered to pay $27.9 million in restitution for his role in a scheme to fraudulently bill Medicare for unnecessary durable medical equipment. “Instead of connecting patients with legitimate care, Reinaldo Wilson used his telemedicine companies to exploit Medicare and line his own pockets,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “He stole over $27.9 million by submitting false and fraudulent claims, robbing a program designed to provide medical care to America’s seniors.
Background and Key Details
The Criminal Division will aggressively prosecute those who defraud Medicare and exploit taxpayer-funded programs meant to serve the people who have paid into the system.”. “Over the span of only two years, Wilson amassed over $56 million in fraudulent Medicare claims, through a cadre of crooked medical providers and co-conspirators, leveraging durable medical equipment for personal financial gain,” said Special Agent in Charge Stefanie Roddy of the FBI’s Newark Field Office. “When criminals defraud Medicare, they undermine the U.S government. The FBI will always work to apprehend theses fraudsters and put an end to their schemes.”.
Moreover, “Today's sentence underscores the serious consequences for those who exploit Medicare for personal gain,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG). “This sentence reflects our commitment to holding individuals accountable when they manipulate providers, target vulnerable patients.
Attempt to conceal fraud behind complex schemes. We will continue working with our law enforcement partners to ensure anyone who abuses federal health care programs is exposed and brought to justice.”. According to court documents and statements made in court, Reinaldo Wilson, 57, formerly of Richmond Hill, Georgia, owned and operated two telemedicine companies located in Bayonne, New Jersey between 2017 and 2019.
Enforcement Actions and Impact
In addition, through these companies, Wilson and others paid illegal kickbacks to medical providers to sign orders for orthotic braces for Medicare beneficiaries, even though the beneficiaries did not need the braces. Wilson and others illegally sold the signed orders to purported marketing companies that often re-sold the orders to brace companies. In turn submitted claims for the unnecessary braces to Medicare. For complete details, refer to the official DOJ press release.
As a result, wilson and his co-conspirators at marketing companies cajoled beneficiaries into accepting as many braces as possible. Providers working for Wilson’s telemedicine companies signed orders for four or more orthotics a piece for over 3,000 beneficiaries. More than 40 beneficiaries received orders for 10 or more orthotics. For related coverage, see Hate Crime Indictment Brought Against An Indian American.
Consequently, wilson also attempted to conceal his crimes by creating a new telemedicine company and convincing a member of his church that it was an investment opportunity. He took $20k from this member and had her open the company and bank accounts in her name. He then took control of. During the conspiracy, Wilson and others submitted over $56 million in false and fraudulent claims to Medicare, of which Medicare paid over $27.9 million. For related coverage, see Unprecedented Discovery at Southern US Border Exposes Chinese Criminal Alliance with Sinaloa Cartel.
In March 2021, Wilson pleaded guilty to conspiracy to commit wire fraud and health care fraud. The FBI, IRS Criminal Investigations (IRS-CI), and HHS-OIG investigated the case. Trial Attorneys Darren C.
Specifically, halverson and Nicholas K. Peone of the Criminal Division’s Fraud Section prosecuted the case. The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program.
Subsequently, since March 2007, this program, currently comprised of eight strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.
What This Means Going Forward
This development underscores the ongoing regulatory enforcement priorities of DOJ. Market participants and compliance professionals should monitor this matter closely.
