Georgia nurse practitioner sentenced to prison, ordered to pay more than $1.6 million in restitution in complex telemedicine fraud scheme
SAVANNAH, GA: A California man who operated a durable medical equipment (DME) company has been charged for his alleged participation in a massive healthcare fraud scheme. The defendant is the 22nd charged in the Southern District of Georgia as part of an investigation that uncovered more than $410 million in fraudulent claims to Medicare, the largest fraud case in the history of the Southern District of Georgia.
Scott M. Hirsch, the operator of JI Medical, Inc., a California company, is accused of conspiring to pay kickbacks in exchange for obtaining orders for DME that JI Medical, Inc. would then bill to Medicare. Those Medicare beneficiaries were located in the Southern District of Georgia and elsewhere. As part of this scheme, the physicians receiving the kickbacks from JI Medical, Inc. knowingly signed false medical records describing “consultations” of Medicare patients. The operator of JI Medical, Inc. was charged by way of an Information, filed in the U.S. District Court for the Southern District of Georgia.
“Telemedicine is an important tool for legitimate providers – but paying kickbacks is not part of telemedicine and will not be tolerated under any circumstances,” said U.S. Attorney Bobby L. Christine. “While many of our prosecutors and law enforcement partners may be working remotely during the COVID-19 pandemic, this office continues to work day and night to bring bad actors to justice.”
The healthcare fraud scheme charged is the largest in the history of the Southern District of Georgia. Previous charges in this string of cases include eight physicians, two nurse practitioners, two operators of telemedicine companies, and two brokers of patient data. The Medicare and Medicaid beneficiaries whose identities were used as part of the scheme are located throughout the Southern District of Georgia, including the Augusta, Brunswick, Dublin, Savannah, Statesboro, and Waycross Divisions, as well as elsewhere in the United States.
The $410 million fraud scheme charged in the Southern District of Georgia is part of nationwide operations by the Department of Justice that thus far has halted a multi-billion dollar fraud network involving fraudulent claims for genetic testing, orthotic braces, pain creams, and other items.
“The growing number of medical providers and equipment providers alleged to have been involved in this ongoing scheme is disheartening,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “The FBI and our federal partners will continue to root out such deceitful practices and protect taxpayers and the citizens who deserve the benefits from programs like Medicare, even as telemedicine becomes more common.”
“This investigation is a stellar example of inter-agency cooperation and working together to bring those who defraud the health care system to justice,” said FBI Birmingham Special Agent in Charge Johnnie Sharp Jr. “The public can be assured that the FBI and our partners will continue to seek to identify and pursue investigations against such egregious offenders.”
“In these trying times, it’s more important than ever that we safeguard the Medicare trust fund,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “HHS/OIG, along with our partners, will vigorously pursue any provider who puts their own financial gain above that of their patients.”
“Cases of this magnitude can only be tackled using a strategy that recognizes that the most effective way to fight these large criminal networks is by combining the strengths, resources, and expertise of our federal agencies,” said Resident Agent in Charge Glen M. Kessler of the U.S. Secret Service. “Our nation’s healthcare system cannot tolerate kickbacks to physicians and pharmacies while criminals line their pockets with taxpayer funded healthcare dollars.”
“The U.S. Postal Inspection Service aggressively conducts investigations of those who fraudulently use the U.S. Mail to facilitate complex fraud schemes,” said Inspector in Charge Joseph W. Cronin of the U.S. Postal Inspection Service’s Boston Division. “We will continue to support and work with our federal law enforcement partners to stop those who are engaged in these types of fraudulent activities and defend the U.S. Mail from criminal misuse.”
“The defendant in this case used the U.S. Mail to facilitate his elaborate criminal scheme. Postal Inspectors partnered with other agencies to quickly identify the scheme and worked aggressively with the U.S. Attorney's Office to dismantle this criminal enterprise. Through cases like these, the Postal Inspection Service upholds its longstanding mission of protecting the public and preventing criminal misuse of the U.S. Mail,” said Antonio J. Gomez, Inspector in Charge of the U.S. Postal Inspection Service - Miami Division.
Indictments or criminal informations contain only charges; defendants are presumed innocent unless and until proven guilty.
This investigation is ongoing. As telemedicine becomes an increasing part of our healthcare system, vigilance in ensuring that fraud and kickbacks do not usurp the legitimate practice of medicine by electronic means is more important than ever. If you are aware of any fraud or kickbacks relating to telemedicine, including COVID-19 fraud, please call the FBI hotline at 1-800-CALL-FBI.
This particular prosecution resulted from a joint investigation of multiple agencies and offices. U.S. Attorney Christine acclaimed the hard work of the investigatory team, led by FBI - Savannah, FBI - Birmingham, the Department of Health and Human Services Office of Inspector General, the United States Secret Service, and the United States Postal Inspection Service.
Assistant U.S. Attorneys J. Thomas Clarkson and Jonathan A. Porter are prosecuting these cases on behalf of the United States.
Barry L. Paschal, Public Affairs Officer: 912-652-4422