Telemedicine CEO pleads guilty in $424 million Medicare fraud scheme

https://www.modernhealthcare.com/legal/telemedicine-ceo-pleads-guilty-424-million-medicare-fraud-scheme?utm_source=modern-healthcare-daily-finance&utm_medium=email&utm_campaign=20190909&utm_content=article1-readmore

The owner of telemedicine company Video Doctor Network on Friday pleaded guilty for his role in what the Justice Department is calling one of the largest healthcare fraud schemes prosecuted to date in the U.S.

Lester Stockett, 52, a resident of Colombia, agreed to pay $200 million in restitution to the U.S. as part of his plea agreement.

The Justice Department in April brought charges against 24 defendants including Stockett for their role in a $424 million conspiracy to defraud Medicare and receive illegal kickbacks. Stockett’s company allegedly received kickbacks from brace suppliers in exchange for arranging for physicians to order medically unnecessary medical equipment, such as back, knee and shoulder braces.

Stockett, owner of the Video Doctor Network and CEO of one of its subsidiaries, AffordADoc, on Friday pleaded guilty to one count of conspiracy to defraud the U.S. and pay and receive healthcare kickbacks, as well as one count of conspiracy to commit money laundering. His sentencing is set for Dec. 16 in New Jersey.

As part of his guilty plea, Stockett said he and others had solicited and received illegal kickbacks and bribes from patient recruiters, pharmacies and brace suppliers. In exchange, he said he and other Video Doctor Network employees bribed healthcare providers to order medically unnecessary orthotic braces for Medicare beneficiaries.

These Medicare beneficiaries were contacted through an international telemarketing network, which identified hundreds of thousands of elderly and disabled patients.

“This CEO and his co-conspirators lined their own pockets with hundreds of millions of dollars by exploiting telemedicine technology meant to help elderly and disabled patients in need of healthcare,” Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division said in a statement.

Brace suppliers, which were co-conspirators in the scheme, submitted more than $424 million in false and fraudulent claims to Medicare for these orders, Stockett said.

Medicare paid brace suppliers more than $200 million for these claims, according to the Justice Department.

Stockett said he and others hid illegal kickbacks and bribes by having them paid indirectly through nominee companies and bank accounts, both in the U.S. and in other countries.

Between March 2016 and April 2019, Stockett said he and other Video Doctor Network executives transferred more than $10 million in illegal kickback payments to a bank account in the Dominican Republic. They then transferred more than $9.8 million from that bank account in the Dominican Republic to bank accounts of AffordADoc in the U.S.

Stockett and other Video Doctor Network executives had also defrauded investors by claiming the company was a legitimate telemedicine enterprise that made $10 million in revenue annually, while revenue was obtained through illegal kickbacks and bribes, according to the plea agreement.

 

 

 

 

FCC moves forward with $100 million Connected Care proposal

https://www.modernhealthcare.com/information-technology/fcc-moves-forward-100-million-connected-care-proposal

The Federal Communications Commission on Wednesday unanimously voted to move forward with plans for a $100 million pilot program to promote telemedicine services.

The FCC voted to adopt a notice of proposed rulemaking for a program dubbed the Connected Care Pilot.

“The future of healthcare is connected care, and this is the future that I want the FCC to support,” agency Chairman Ajit Pai said at an open meeting Wednesday. “The $100 million budget we propose for the Connected Care Pilot program is a smart investment for us and for the country.”

A year ago, FCC Commissioner Brendan Carr unveiled plans for a program that would allocate up to $100 million to support telemedicine projects. The three-year program, dubbed the Connected Care Pilot, would support a limited number of projects, focusing on pilots that help providers “defray” the broadband costs of bringing telemedicine to low-income Americans and veterans.

Unlike existing FCC healthcare programs, such as the agency’s Rural Health Care Program, the proposed pilot would focus on projects that connect patients with healthcare services directly and outside of a hospital.

With the vote, the FCC formally proposed the Connected Care Pilot and said it plans to seek public comment on what kinds of healthcare and broadband service providers should be eligible for the program, as well as what goals and metrics the program should set and how the agency should gather data during the program.

Telemedicine has provided benefits for patients with diabetes, opioid dependency and post-traumatic stress disorder, among other conditions, Carr said during the meeting. He cited data from the U.S. Veterans Affairs Department, which found a remote patient-monitoring program had reduced days of inpatient care by 25% and hospital admissions by 19%.

The VA’s remote patient-monitoring program cost $1,600 per patient, compared with $13,000 per patient for traditional care, Carr said.

“Given the significant cost savings and improved patient outcomes associated with these pilots, we should align public policy in support of this movement in telehealth,” Carr said, adding that data from the FCC’s Connected Care Pilot will likely be able to help inform future policies to promote telemedicine. “It’s the healthcare equivalent of moving from Blockbuster to Netflix.”

Providers largely expressed excitement about the program last year, though some warned the FCC needed to establish more detailed metrics for success. The FCC is seeking feedback on what metrics and data to collect as part of its upcoming request for comment on the program, according to its notice of proposed rulemaking.

“There are many ways to pitch the benefits of broadband, but (I’m) hard-pressed to think of one more powerful than telemedicine,” Pai said at the meeting.

Despite the unanimous vote, commissioners did raise some concerns.

FCC Commissioner Michael O’Rielly questioned budgeting for the program. As written, the proposed Connected Care Pilot would be funded by the Universal Service Fund, a fund managed by the FCC that collects fees from telecommunications companies. The FCC uses these contributions to subsidize services for low-income and rural areas.

O’Rielly said that the FCC has not proposed including the Connected Care Pilot within any of the Universal Service Fund’s existing programs.

“However, $100 million in funding must come from somewhere,” he said, suggesting the program will result in telecommunications companies being asked to pay larger contributions to the USF. “I appreciate Commissioner Carr for the work on the (Connected Care Pilot), and look forward to more discussions raised in context of the larger USF.”

 

 

 

Medical costs projected to increase 6% by 2020, says PwC

https://www.healthcarefinancenews.com/news/medical-costs-projected-increase-6-percent-2020-says-pwc?mkt_tok=eyJpIjoiWldZeVlXTm1aVEF6TVdKbSIsInQiOiJjbWFzeVA2TGlWZkNkXC9odGxcLzdLczFZSDYxd1hoYW04b0wxY0ljQ25zblpYN1VWc2FMWFFCQWpmc2tCYmE4d1Z3eVdMd2htY3JiSjZ3N2Urek43SHFJbWFsckdRbUNycFJoQjhzZm5VcGpJUUhKUDlBMWF2eGJzRUhmZGFlUUx0In0%3D

Utilization is still being dampened by high deductibles and other cost sharing, but at the expense of employee satisfaction.

Medical costs are rising, and by this time next year costs will likely show a modest increase of about 6% over the past two years, according to a new report from PwC, PricewaterhouseCoopers.

After figuring in health plan changes such as increased employee cost sharing and network and benefit changes, PwC’s Health Research Institute, which conducted the study, projects a net growth rate of 5 percent. Even with employers’ actions, market forces likely will still overrun the efforts to quell them.

Prices, not utilization, are continuing to fuel healthcare spending. Utilization is still being dampened by high deductibles and other cost sharing, but at the expense of employee satisfaction with their health plan. In response, employers are inserting themselves more forcefully into the healthcare delivery equation.

WHAT’S THE IMPACT

Beyond market forces, HRI identified three “inflators” that will, influence the medical cost trend.

One is that drug spending will grow faster. Between 2020 and 2027, retail drug spending under private health insurance is projected to increase at a rate of 3 percent to 6 percent a year as the impact of generics on spending plateaus, biosimilars continue to see slow uptake, and costly new therapies enter the market.

Chronic diseases will also be a major issue. Obesity and Type 2 diabetes continue to produce high rates of hypertension and cardiovascular disease. Sixty percent of adults have a chronic disease, with 40 percent managing two or more. For employers, per capita health spending on someone with a complex chronic illness is eight times that of a healthy person.

Lastly, employers are beginning to recognize the importance of helping their employees manage their mental health and wellbeing. Nearly 75 percent of employers offer mental health disease management programs, the report found. Anytime access is expanded, costs will go up in the short term, though it may have the opposite effect long-term.

And speaking of the opposite effect, there are a few “deflators” HRI recognized that will likely slow down the medical cost trend.

HRI predicts that in 2020, more companies will take action to make sure healthcare is accessible to their employees, opening and expanding clinics as a strategy to control the cost trend. Thirty-eight percent of large employers offered a worksite clinic in 2019, up from 27 percent in 2014.

Also, payers are designing plans to encourage members to choose free-standing facilities and in-home care rather than more expensive sites. How those benefits are designed, and how employees perceive the costs, will shape the effectiveness of site of care strategies. Payers and employers are aiming to grow the role of telemedicine as employees grow more comfortable with it, especially if out-of-pocket costs are lower and the quality doesn’t suffer.

WHAT ELSE YOU SHOULD KNOW

The trend has implications for employers, payers, providers and even pharmaceutical and life science companies.

For payers, it becomes important to  benchmark the prices paid commercially against a common reference point such as Medicare. With this information it’s possible to pursue value-based arrangements with high-performing and lower-cost providers, in addition to negotiating better contracted rates on existing fee-for-service arrangements.

For providers, a value line strategy is necessary as employers and consumers look for high quality care for a low cost. Providers armed with a value line strategy are more likely to be included in health plans’ high-performance networks, and are better positioned to directly contract with employers.

Providers should also understand what risk they can take on to guarantee a health outcome, and the cost structure needed to make them profitable in doing so. Providers should understand and manage both the risk inherent in their ability to deliver care and the risk of the population they’re managing — from health status to the social determinants impacting their health — to help them design appropriate clinical interventions and non-clinical support services.

For employers, it becomes imperative to understand their role as the purchaser of healthcare for employees and join the ranks of employer activists, pursuing new solutions to lower costs, improve access and enhance quality. Pharmaceutical and life science companies, meanwhile, should go beyond the basic outcomes-based arrangements currently in place and consider exploring and expanding alternative financing arrangements, such as subscription models for unlimited access to a product for a set period of time, or a mortgage model to finance expensive specialty drugs over time.

THE LARGER TREND

The PwC study loosely mirrors the findings of an October report from the Altarum Center for Value in Health Care, which found prices and spending in healthcare growing steadily, but at a moderate pace.

The country’s healthcare spending habits are at a level nearly double that of similar countries. Spending per capita in the U.S. is more than $9,000, compared to just over $5,000 in other Western nations, and because prices are growing slowly but steadily, spending is doing the same.