Orthopedic Surgeon in NY Indicted in $10 Million TeleHealth Fraud by U.S. Attorney Breon Peace

Orthopedic surgeon, Elemer Raffai, 56, of Rome, N.Y., was arrested on April 21, 2022, and charged with Telehealth Fraud. Dr. Raffai is accused of participating in a $10 Million False Claims Act scheme. He allegedly submitted false and fraudulent claims to Medicare and Medicare Part D plans. See eg DOJ Press Release.

According to court documents filed by the DOJ, between July 2016 and June 2017, Dr. Raffai signed prescriptions and order forms via purported telemedicine services for durable medical equipment. The problem is, this equipment was probably not medically necessary. Dr. Raffai caused these claims to be submitted based solely on a short telephone conversation. He did not physically examine and evaluate the patients as required. Even worse, the indictment alleges he was induced to do so by bribes and kickbacks from telehealth companies. He was allegedly paid $25 or $30 per patient consultation.

Hard to believe that a surgeon would stoop to such small change medicare fraud. But I guess it can add up and become a real cash cow. Dr. Raffai now faces a maximum total penalty of 10 years in prison, plus fines. No private Relators appear to be involved.

The indictment alleges that Dr. Raffai, with others, submitted or caused the submission of approximately $10 million in false and fraudulent claims to Medicare for this equipment. Medicare paid more than $4 million on those claims.

The Health and Human Services, Special Agent in Charge of the investigation, Scott J. Lampert, stated:

These allegations describe a physician who is more motivated by personal enrichment than his duty to provide appropriate and necessary care to his patients. Dr. Raffai is accused not only of disregarding proper patient care, but also of pilfering funds from a program upon which millions of citizens depend for health services.

Breon Peace, U.S. Attorney

The New York Eastern District, United States Attorney, Breon Peace, who is in charge of the prosecution, added:

Dishonest doctors who think Medicare is a cash cow and connect with telemedicine companies to brazenly steal from this vital taxpayer-funded program will find themselves arrested, prosecuted and their scheme disconnected.

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