Operation Happy Clickers Holds Medical Providers Responsible for Roles in Telemedicine Fraud Schemes

By: Jesse Adam Markos, Esq.

Wachler & Associates, P.C

The U.S. Attorney from the Western District of Michigan recently announced criminal and civil enforcement actions taken as part of a joint-agency healthcare fraud operation targeting medical providers who signed off on illegitimate orders for durable medical equipment (“DME”) or medical testing promoted by telemarketers. The investigation is being called “Happy Clickers” in reference to the hasty approval of orders by medical providers with little or no review and is similar to other nationwide operations targeting marketers and owners of DME supply companies who have conducted schemes designed to defraud the Medicare Program. However, Operation Happy Clickers also illustrates the increasing willingness of healthcare fraud investigations to also hold medical providers accountable when they participate with marketers and owners in fraud schemes.

By way of background, telemedicine has developed into a viable and cost-effective alternative to traditional care delivery. Many providers have become interested in telemedicine as way to expand access to care by bringing it directly into the patient’s home. Innovation in care delivery and technology has been transforming the practice of medicine. Video-conferencing technology is sufficiently advanced, high-tech computers, phones and tablets are more affordable, and patients are being exposed to video technologies in numerous other industries. As such, with a successful practice model, providers are just as prepared to deliver care through telemedicine-based technologies as they are with a traditional visit.

With healthcare costs on the rise, telemedicine is a valuable tool for delivering better outcomes and quality care at lower costs. In many cases, a remote consultation is a more time and cost-efficient way to provide an equivalent service compared to an in-office practice. By coordinating care properly to include the use of telemedicine and by reducing the number of unnecessary emergency room visits, healthcare organizations can also manage patients in the most efficient and least costly manner possible.

Many providers who branch out into telemedicine wish to focus solely on the clinical aspect. They do not have the resources to launch or operate their own telemedicine platform. As such, they often chose to affiliate as a contracted provider with an existing service and often have little to no involvement regarding marketing or billing. However, providers must be cautious when affiliating with a telemedicine company and carefully identify any red flags indicating that the items and services offered may be illegitimate.

Medical providers have an obligation to conduct a good faith review of DME and tests being ordered. Because their approval is necessary for Medicare to pay for ordered items and services, providers are the line of defense against fraud schemes and investigations like “Happy Clickers” confirm that providers who are affiliated with the fraudulent approval of DME or testing through telemedicine services may be held criminally and/or civilly liable. For additional information or assistance regarding this, or any other related issue, contact Jesse A. Markos, Esq., at Wachler & Associates at (248) 544-0888.