AffordADoc: The Patients Weren’t Paying for the Consultations

AffordADoc’s owner and chief executive officer admitted in his guilty plea that he received brace-order kickbacks, paid clinicians for unnecessary orders and concealed the money in accounts held in other names. He presented the business as patient-funded telemedicine, while the money came from buyers of its orders. For someone inside the company, that difference could be visible in an invoice, a bank transfer or an explanation given to a doctor about who paid for the work.

The Justice Department announced the owner’s plea on September 6, 2019. His admissions connect the clinical side of the business to its financing: unnecessary orders generated revenue, and he hid where that revenue came from.

The Companies Behind the Brace Orders

The original criminal indictment identified AffordADoc as the business name of Telemed Health Group, LLC and grouped it with Video Doctor USA under the name Video Doctor Network. The indictment also identified PCS CC, LLC, doing business as Procall, as a call-center company operating in Latin America. It alleged that the telemedicine network recruited practitioners, received patient information for brace orders and passed those orders to durable medical equipment suppliers for Medicare billing. That division of work put the patient contact, the doctor’s signature, the equipment claim and the money in different hands.

How the Order Became a Medicare Claim

The order was the product that connected the telemedicine operation to Medicare payment. The indictment alleged that the network facilitated brace ordering by charging neither beneficiaries nor Medicare for the purported consultations. It paid healthcare providers to produce orders and passed those orders to suppliers, recruiters and others to support false claims.

The owner’s guilty-plea announcement described call centers in the Philippines and Latin America. The business could reach patients from overseas call centers, obtain orders through a telemedicine network and generate equipment claims in the United States.

The indictment described why the signature mattered. A Medicare equipment claim identified the beneficiary, the service date and cost, the ordering professional and the supplier. It also had to represent medically necessary equipment actually provided as claimed. The network allegedly fabricated and altered orders and other records to support bills for equipment that failed those requirements.

For an insider, the practical consequence is easy to miss: a search confined to paid telehealth visits can miss the business that produced the equipment order. The consultation could generate no bill while its resulting order enabled someone else’s payment. The supplier’s claim and the telemedicine company’s order records belong in the same account of what happened.

Patient Memberships on Paper, Supplier Money in the Accounts

The owner’s admissions describe payments from order purchasers concealed behind a patient-membership revenue story. The original indictment gives that story its detail: the network allegedly told doctors, investors and others that beneficiaries enrolled in a membership program and paid AffordADoc for consultations. It also allegedly denied receiving money, directly or indirectly, from durable medical equipment suppliers or marketers.

The same alleged pitch put revenue at about $10 million per year, with 20% profit. The indictment described an ordinary membership model in which patients paid monthly for telemedicine access and a fee for each physician encounter. AffordADoc’s alleged explanation borrowed that familiar model to make order-buyer money look like patient revenue.

According to the indictment, supplier money instead reached the network through companies and bank accounts held in other names. Accounts were located in the United States and foreign countries, including the Dominican Republic.

The accounting supplied another disguise. The indictment alleged sham agreements, false invoices and payments labeled as “marketing” or “business process outsourcing” expenditures. Those labels described services a company might buy. The alleged transaction underneath them bought access to brace orders.

The indictment traced payments into accounts for Video Doctor USA and Procall. The recipient’s name on a transfer therefore showed only part of the transaction. The important connection was between the money, the people controlling the recipient and the orders the purchaser received.

That is why the stated source of revenue matters to a whistleblower. A clinician may hear that patients are paying for care while someone in accounting sees money arriving from an order buyer. Taken together, those accounts can expose the explanation the company gave each side.

What Medicare Was Billed and What It Paid

The owner’s guilty-plea announcement described more than $424 million in claims and more than $200 million paid by Medicare. The indictment alleged that suppliers submitted the bills using orders obtained through kickbacks, orders for unnecessary equipment and records that misrepresented what was provided. The money reached the suppliers through Medicare claims, while payments for the orders helped finance the telemedicine operation. The business claimed that patients funded the consultations. Taxpayers paid for the unnecessary braces ordered through them.

What Is a Red Flag for Health Care Fraud?

In an order business like this one, the red flags concern who recruited the patient, what the practitioner actually knew and what triggered payment. The HHS Office of Inspector General’s July 20, 2022 telemedicine fraud alert describes companies that recruit patients, pay practitioners for unnecessary orders and sell those orders to businesses that bill federal health care programs.

The alert identifies arrangements in which patients arrive through promotions for free or low-cost items, practitioners receive too little contact or information to assess medical need, and compensation follows the volume of orders. A payment described as a chart review can still be tied to how many items are ordered.

The alert also flags a single product or product class and no expected follow-up, or no information that would make follow-up possible. Those features put the company’s control over care alongside its control over payment.

For an insider, these features bring the business into focus. Recruitment records show how the patient entered the business. Clinical records show what information reached the practitioner. Compensation terms show what the company paid to produce. That combination gets closer to the order’s purpose than the word telemedicine on a contract.

What Evidence Is Needed to Prove Fraud?

The evidence that matters ties together what the order said about the patient, who paid for the order and what Medicare was billed. We examine those connections with the insider who knows how the company produced the orders and described the money.

A separate physician’s September 12, 2019 guilty-plea announcement shows how concrete the clinical discrepancy can be. The physician admitted writing unnecessary brace orders for telemedicine companies without speaking to the beneficiaries. He also admitted falsifying orders to say he had spoken with patients or conducted diagnostic testing when he had done neither.

The false statement was inside the document that made the order look medically supported. An employee who knows how those forms were completed may see something that the equipment claim alone cannot explain.

A 2024 analysis in Rutgers University Law Review, Plausible Cause: Connecting the FCA and AKS in the Context of Health Care Fraud, examines the connection between kickbacks prohibited by the Anti-Kickback Statute and false claims under the False Claims Act. It points to the telemedicine alert’s business characteristics as useful evidence of how an arrangement produces the claims at issue.

In this kind of business, the doctor’s file and the bank records tell parts of the same story. The doctor’s file may explain the asserted need for a brace. The supplier’s bill shows how that assertion reached Medicare. The invoice and bank records may explain who paid to obtain the order and how the payment was disguised. An insider’s knowledge can connect decisions that otherwise appear in separate businesses’ records.

The Civil Whistleblower Opportunity

The same kind of order-and-payment evidence can matter in a civil whistleblower case. The inspector general’s alert expressly connects fraudulent telemedicine orders to claims under the False Claims Act, including claims submitted by a business other than the practitioner who signed.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. Our work with you starts with what the company represented, what you know happened and how the orders reached the government bill.

You Know Who Was Paying

If you saw order buyers funding supposed patient consultations, or patient records written to support care that never happened, tell our whistleblower experts what you saw. We pair your knowledge of paid orders and concealed revenue with telehealth fraud whistleblower lawyers who understand Medicare billing. We stay beside you through the case, turning what you know about the orders and the money into a demand for accountability.