Telemedicine Physician False Statements: Portal Signatures Without Contact or Follow-Up

In a Missouri telemedicine guilty plea, a physician admitted falsely certifying that durable medical equipment and genetic tests were medically necessary for more than 2,000 Medicare and Medicaid patients he had never met or examined. A staffing company supplied patient information through electronic portals, and he supplied the signatures. For a clinician receiving these assignments, or an employee sending them onward, the central question is what happened between the arrival of the patient information and the declaration that someone needed the product.

The Justice Department’s September 21, 2022 account of the criminal plea describes a former Joplin, Missouri, physician who pleaded guilty to conspiring to make false statements related to health care matters. In his guilty plea, he admitted knowing his orders would support claims to the public programs. The signature supplied a medical judgment he had no adequate information to make.

The Staffing Company Supplied the Orders

The physician contracted with a staffing company to work as a telemedicine provider. In the criminal plea account, the company supplied access to electronic portals containing information about assigned patients. He reviewed that information and electronically signed the forms and orders the company sent him.

The documents had distinct jobs. An order authorized durable medical equipment or genetic testing. His certification represented that the item or test was medically necessary. For genetic tests, he also signed a separate letter of medical necessity. That letter put a physician’s authority behind the request for a test, even though he had never communicated with the beneficiary.

The staffing company paid approximately $20 for each signed order. The physician received $44,860 in total. His compensation attached to the signature, the part of the transaction the suppliers and laboratories could use to support their claims.

The Justice Department’s criminal plea account says marketing, physician recruiting and telemedicine companies developed the wider scheme. The staffing firm supplied the assignments, the physician signed, and durable medical equipment companies and clinical testing laboratories received the orders. The public programs paid claims submitted by those suppliers and laboratories.

Patient Information With Little Verification

According to the criminal plea account, the physician had no doctor-patient relationship with the beneficiaries and did not see or communicate with any of them. He made little effort to determine who had collected the patient information, how it had been obtained, or who had supplied it. He did little to establish the qualifications of the people gathering or providing it. He also did little to check whether it was accurate and complete. The missing connection ran all the way from the person gathering the history to the physician certifying the order.

Those details matter to a clinician who knows how much a medical decision depends on the source of a history. A portal can deliver a completed form while leaving the physician without an adequate basis for the conclusion printed beneath it. Here, the physician adopted that conclusion and certified necessity anyway.

The Centers for Medicare & Medicaid Services’ March 2020 explanation of patient-portal e-visits describes patient-initiated exchanges with an established practice. Here, the staffing company assigned the orders, and the physician never spoke with the patients.

The criminal plea account also says he provided no follow-up after signing the equipment and test orders. His involvement ended with the document that allowed the next business to seek payment. The test had a doctor’s certification behind it. The patient had no follow-up care from that doctor.

Less Than a Minute to Certify Medical Necessity

For many or most patients, less than a minute elapsed between the physician opening their information in the portal and signing the order, according to the Justice Department’s account of the criminal plea. He rarely, if ever, declined an order from the staffing company.

He declared that equipment or a test was medically necessary without adequate information to assess that need. Taxpayers paid for products backed by a medical judgment the physician had no basis to make.

The physician admitted signing the necessity certifications and knowing that the orders would support Medicare and Medicaid claims. The Justice Department’s account says he knew his statements were untrue when he made them.

An insider may know what information was available, what patient contact occurred and what the completed form claimed. Here, the signature said more than the work behind it could support.

Small Signature Payments Supported Large Claims

According to the criminal plea account, the physician ordered equipment and genetic tests for 2,184 Medicare beneficiaries between March 2019 and April 2021. His durable medical equipment orders caused Medicare to be billed more than $6.2 million. Medicare paid the equipment companies almost $3.1 million. His genetic-test orders for Medicaid beneficiaries caused laboratories to bill more than $2.5 million, of which Medicaid paid almost $525,000. The claims drew public money through the businesses receiving the signed orders.

The Justice Department also reported that many of the suppliers and laboratories paid illegal kickbacks to people and entities unknown to the physician. The physician’s role was supplying false medical-necessity documents while knowing where they would be used.

Another Portal Turned Approval Into Signed Forms

In a separate Delaware civil settlement, a physician admitted approving genetic tests through MySpecialistMD without an existing treating relationship, applying her signature to orders and medical-necessity documents. The comparison is again between the clinical relationship represented by the signed paperwork and the contact the physician actually had.

What Evidence Is Needed to Prove Fraud?

Our whistleblower experts work with insiders to connect what they know about patient information, signed orders and payments to the claims those orders supported. If your view stops at the staffing company, supplier or laboratory, we work with you to understand where your knowledge fits and build the case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

A clinician may know what the assigned chart contained and whether anyone spoke with the patient. A staffing employee may understand the assignment and payment arrangement. Someone inside a supplier or laboratory may see which signed orders supported the claims. Those views can connect the clinical representation to the money it brought in.

The pattern also appears in the HHS Office of Inspector General’s July 2022 telemedicine fraud alert. It describes companies supplying patient information, compensating reviews or signatures and transferring the resulting orders to downstream buyers. Among the characteristics it identifies are inadequate contact or information, compensation tied to order volume and absent follow-up. Those are concrete features of the workflow described in this plea account.

You Know What Happened Before the Signature

If you know how patient information became signed equipment or test orders, speak to one of our whistleblower experts about what happened before the signature. We build your case around the clinical decisions and payment arrangements you can explain, bring in healthcare fraud whistleblower lawyers who understand telemedicine order schemes, and stand beside you throughout the case.