Operation Brace Yourself: The Brace Order Was for Sale

Operation Brace Yourself was the April 2019 federal health care fraud action against an alleged market for medically unnecessary Medicare brace orders. The government accused marketers of finding beneficiaries, telemedicine companies of paying doctors to prescribe braces, and durable medical equipment suppliers of buying the orders and billing Medicare. The brace was the product shipped to the patient. The signed order was the product sold between businesses. If you worked in those calls, payments or orders, you may recognize how a sales decision became a medical document.

The Justice Department’s April 9, 2019 announcement of the criminal charges described more than $1.2 billion in alleged losses and charges against 24 people. The defendants included telemedicine executives, equipment-company owners and three licensed medical professionals.

The criminal charges alleged that call centers in the Philippines and throughout Latin America recruited hundreds of thousands of elderly or disabled patients. The orders concerned back, shoulder, wrist and knee braces. Doctors allegedly prescribed them without speaking to the patient or after a brief telephone conversation with someone they had never met or seen.

How Does DME Fraud Work?

The Operation Brace Yourself criminal charges described durable medical equipment fraud built around buying the orders needed to bill Medicare. The charges alleged that the call center advertised to beneficiaries and encouraged them to accept multiple free or low-cost braces regardless of medical need. It then paid telemedicine companies to obtain orders, and those companies paid physicians to write them.

The charges alleged that the call center sold the completed orders to equipment suppliers. The suppliers submitted the Medicare claims. The charges also alleged that proceeds moved through international shell companies and paid for luxury real estate, automobiles and yachts. The alleged scheme connected overseas calls, American Medicare claims and offshore money transfers.

The ordinary industry workflow explains why that document mattered. Advertising produces a response. A call center captures the beneficiary’s information and insurance details. A practitioner supplies the order, and an enrolled supplier ships or fits the equipment and bills Medicare. Each business can handle only part of the transaction while the supplier receives the claim payment.

The HHS Office of Inspector General’s July 2022 telemedicine fraud alert describes the order itself as something a telemedicine company can sell to another business. It also describes practitioner payments called fees for a review, audit, consultation or chart assessment. The commercial question is what that fee bought: the time to assess a patient, or another signed order ready for a supplier.

Who Commits Medicare Fraud?

The Operation Brace Yourself charges accused marketers, telemedicine companies, clinicians and suppliers of working together to defraud Medicare. Looking at those roles explains how the alleged scheme could operate across many companies without every participant handling a Medicare claim.

Telemedicine Companies Connected the Call to the Signature

The Justice Department named Video Doctor USA, AffordADoc, Web Doctors Plus, Integrated Support Plus and First Care MD in its appeal for information from medical professionals about alleged telemedicine and equipment-marketing schemes. Those company names matter to someone who knew the work through a contract, a scheduling system or a payment rather than the operation’s public name.

The New Jersey charges included an owner, a chief executive and a marketing executive associated with purported call centers and telemedicine companies. The Florida charges included an owner of two telemedicine companies, while a Texas case concerned another telemedicine-company owner. The government alleged that these businesses solicited kickbacks for referring equipment orders to suppliers.

That places the telemedicine business between the person recruited by a marketer and the clinician whose signature the supplier needs. Its staffing arrangements, chart assignments and compensation records explain how the order reached the signer.

Clinicians Supplied the Medical Approval

The criminal charges described different versions of the clinical gap. A New Jersey physician allegedly wrote unnecessary orders while working for two telemedicine companies, often without speaking to the patients. A North Carolina physician allegedly wrote unnecessary orders for a telemedicine company after only brief telephone conversations.

A real signature can make a deficient order look complete. The important comparison is between what the form says the clinician did and the contact and clinical information behind it. In its later alert, the Inspector General identified arrangements in which practitioners received too little patient information to assess medical need, worked from templated histories, or were paid according to the volume of items ordered.

An order can therefore carry the correct clinician’s signature while the sales process has already chosen the treatment. The signer, the person preparing the chart and the employee paying for completed reviews see different parts of that decision.

Suppliers Bought Orders and Submitted Claims

The supplier-side charges show how the alleged market served businesses with multiple company names. In California, the government charged the owners of seven durable medical equipment companies with paying kickbacks for medically unnecessary orders. In New Jersey, it charged owners of approximately 25 equipment companies over the same kind of purchase. The South Carolina charges reached an owner of more than a dozen companies involved in the alleged scheme.

For an employee, the meaningful connection is the one between the purchased order and the supplier that billed it. An order invoice, the supplier’s claim and the fulfillment record describe different parts of the same sale. The company paying the marketer may be the place where those parts can be connected.

When the Sales Call Has Already Chosen the Brace

A separate whistleblower complaint concerning KPM Capital, doing business as Western Medical Group, described a sales pitch that made present medical need beside the point. The complaint quoted a sales representative telling a beneficiary:

In that pitch, taxpayers were expected to pay for a brace the patient did not need yet. The whistleblower alleged that the business prepared the written order and sent it to the beneficiary’s physician with representations that the patient had requested the equipment. The complaint alleged that physicians or their staff routinely signed the prepared request. That allegation shows another route from a sales call to a genuine signature: a patient’s own physician could receive a form whose account of the patient’s request was false.

The whistleblower also alleged that the business might be using four provider numbers to keep its sales volume less visible to Medicare auditors. The same question runs through Operation Brace Yourself: who decided that the beneficiary needed a brace before the physician saw the order?

CMS Stopped Supplier Payments Alongside the Criminal Cases

The Centers for Medicare & Medicaid Services suspended payments to 130 durable medical equipment companies that had already received more than $900 million on over $1.7 billion in claims, according to the Justice Department’s announcement.

What the Operation Changed

The Justice Department later reported estimated reductions in Medicare brace spending after Operation Brace Yourself. Its September 2021 announcement put the estimate at more than $1.9 billion over 20 months after the action.

Does DME Require Prior Authorization?

Some durable medical equipment requires prior authorization, with requirements tied to the particular item. For braces, the Centers for Medicare & Medicaid Services’ January 13, 2022 notice selected five orthosis codes for a rollout beginning in April 2022. The notice cited the unnecessary-brace cases and the administrative action against suppliers offering low-cost or no-cost braces.

The Later Software Indictment: An Alleged Order Factory on a Platform

A separate criminal indictment described by the Justice Department alleged that a software platform generated and sold templated doctors’ orders for orthotic braces and pain creams. The government accused the platform’s operators of connecting telemarketers and telemedicine companies to coordinate kickback payments for orders.

The indictment alleged that the software generated false certifications of in-person examinations and diagnostic testing, while concealing that the beneficiary interactions had occurred remotely. It also alleged that new corporate leadership continued the scheme after an acquisition.

That later allegation puts the software configuration beside the clinician’s signature. A standard field in an order template can say an examination happened. The people who chose that field, supplied the clinical information and approved the finished order can explain how it got there.

What Evidence Is Needed for Reporting Fraud?

We work with insiders to connect the beneficiary’s original contact, the clinical basis for the order, the payment for obtaining it and the Medicare claim. A signed form may look complete while the chart behind it or the payment for it tells a different story.

The Inspector General’s alert also identifies arrangements built around a single product, insufficient patient contact and no expected follow-up. Someone inside that workflow may know whether the practitioner could choose a different treatment, decline an order or obtain more information before signing. That knowledge gives a complete-looking document its context.

For a call-center employee, the story may begin with what the beneficiary actually requested. For a clinician, it may begin with a chart that did not support the order already prepared. For a supplier’s billing or accounting employee, it may be the link between the order purchase and the claim. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What Happened Before the Signature

If you know who bought the brace orders, what the clinician actually reviewed or how the supplier billed them, speak to our whistleblower experts about your case. We build the case strategy with you and bring in Medicare fraud whistleblower lawyers who understand paid referrals and telemedicine orders. We stay beside you from the first account of the scheme through the decisions that move your case forward.