I get solicited constantly to do telemedicine because of my LinkedIn profile and because of this blog. Just like there are many clinic schemes out there to defraud CMS, there are many telemedicine scams.
I came across an interesting discussion on this forum when doing a search for this topic. To summarize the discussion: this physician was doing work for a telemedicine company which only deals with DME prescribing. Their fraud antenna went up and they decided to post about it online and see what others thought.
Word of caution, if you think something is potentially shady, don’t post about it online. There are steps you can take to protect yourself as I’ll discuss towards the end of this post.
Before I dive into this topic, let me share with you guys a story I’ve promised for the past 4 years but never actually delivered. In fact, this post today marks my 1,001-st post. I have written the equivalent of 18 novels or 1,500,000 words.
Medicare fraud clinic
It was 2009 and I was a moonlighting whore. I had found all of the best Los Angeles urgent cares, clinics, and ER’s to moonlight in, while simultaneously holding a chief resident position at UCLA.
I come across a job posting on monster.com: ‘Medical director wanted for Los Angeles clinic’. I considered it because I was about to finish my residency and why not land a job like that!
I call them, talk to the office manager on the phone, and we setup a time to meet at the clinic.
I show up to a bustling clinic; 3 MA’s working in the back, a PA seeing patients, 7 live exam rooms, and some patients in the waiting area.
The guy I met, Mike, was the office manager and told me that the old medical director had suddenly left. Retired? No, just left, no reason given.
The responsibilities were simple – oversee the PA. I didn’t even have to see any patients but would have to audit about 25% of the charts and offer any feedback. If I agreed to see some patients then I could make extra but it would be minimal. They preferred if I would agree to oversee even more PA’s.
I’m in! I had no idea how a clinic runs, nobody in my residency or from the medical board ever bothered explaining anything to me. I signed a shit-load of documents, I opened a business account under my name and added the office manager as a joint account holder.
I wasn’t supposed to start for another 2 months. But not even 2 weeks go by and there is $25k in my account. Then $50k. Then $100k. I call up Mike – what the fuck dude!? Where is all this money coming from, I haven’t even seen any patients.
Oh don’t worry Dr. Mo – these are patients the PA has been seeing and money Medicare owes us. At the end of each month you will get your share as the medical director.
Something was wrong so I went and talked to my residency director. A very smart woman with 25 years of practice experience at UCLA. Sadly, she had no clue about the real world – she’d been seeing and teaching at UCLA ever since residency. But she suggested I talk to UCLA’s legal team.
The legal team was wishy washy about it. They couldn’t tell me if it was legit or not but that I should reach out to Medicare.
I call Mike: Nah man, I’m not doing this. Sorry, wish I could help you guys but this isn’t the right thing for me. He gets angry on the phone – you cost us all this money, you’re not leaving, you’re in it with us or else we will report you to Medicare.
Fuck that shit, these motherfuckers were definitely shady! I rush over to the bank that same night, tell them I want to close the account and take all the money out. They banks gives me the $100k but wouldn’t let me close the account.
I call and email, and call and email the FBI as well as Medicare for 2.5 months to tell them about this situation – nothing. I now have all the cash stashed in my house and have 2 Russian guys calling me left and right: we know where you live! Who the fuck do you think you are?! We know you took our money, we’re coming after you.
Fecal material abound in my tighty whities, I decide to call the FBI one more time. Eventually one of the guys promised to get back to me. A week goes by and I get a call: This is agent FuckFace from the FBI, is this Dr. Mo? Can you explain to me how you have managed to bill $1.5M in the past 4 months? I know you’re a fraud and we’re coming after you.
I-fucking-lose-it on this moron on the phone! I got off on the guy while I’m driving, telling him that I’ve been trying to report this shit to them for the past few months and that they haven’t done shit. That I’ve had this money with me for all this time and been trying to stay low to not get wacked by Vlad and Boris. He pauses….. okay, let me get back to you.
I get a call from another FBI guy: hi Dr. Mo, could we have you meet with 2 of our agents tomorrow at UCLA? Yes, for fuck’s sake, yes!
I meet with 2 FBI agents, I hand them over the money. They tell me that by handing the money over I’m forfeiting all rights to this money and that I am now actively involved in this investigation. Huh? I don’t get it, am I not doing the right thing? But fuck it, I needed this money out of my house.
Okay, now, can you meet us at our headquarters for an interview? Sure. You guys are gonna take these guys into custody right? I don’t want to die. Silence.
I show up to the FBI station, walk into a large conference room, 7 people are sitting around a large table. A recorder in the middle. A stack of documents.
W….T…..F?! Why do I feel that I’m about to get grilled?
And I get fucking grilled! One person jumps in and tells me that my answers don’t match. Another jumps in and totally changes the line of questioning. They show me mug shot, they show me undercover photos, they show me bank accounts, signatures, cars, photos of the clinic, photos of the people who could have been there that day when I was at the clinic.
I’m soaked, sweating through all layers. These fucks then ask me if I am willing to go undercover, wear a fucking microphone, and go back into that fake medical office in order to implicate these guys.
No-fucking-way! I’m not doing that shit, that’s your job, leave me out of this!
It took 3 more years. Every few months new agents were assigned to my case. They kept showing me photos of these guys and I kept asking the same question: why the fuck haven’t you guys caught them yet?! And why the fuck are they still billing under my name?! In total, $3M was billed to Medicare under that fake business.
3 years passed, it’s 2012 and I had moved to San Diego. I get a knock at my door. 2 FBI agents – can we come in? Not really, no, I’m done with you guys. Well, we insist. Fine. They come in and the same thing – more questions and more photos.
But I had it with these guys. I kept answering that I don’t know, I don’t remember. I was as uncooperative as I could be.
I told them that this was the very last time they were allowed to call me or show up at my doorstep. They were nice about it and they said fine, we won’t be contacting you anymore. And that was it. I didn’t hear from these guys ever again. And I never got whacked by Vlad or Boris – so this is a happy ending, feel-good story.
Wasn’t that fun? That’s the shit I had to deal with on my own. No lawyer, nobody to guide me. Nobody ever taught us this stuff – how to recognize a scam and how to protect ourselves in case we found ourselves in the middle of this shit.
Apparently, these were common scams run by Russian mafia guys back then. Fortunately, they rarely were violent. They found dumbass doctors who were money hungry and would scam Medicare out of lots of money. They would empty the bank accounts as quickly as they could and move on to the next clinic site and to the next doctor before they could be indicted.
My saving grace was that I recognized it early, returned the money to the FBI, and so there was no signs that I could potentially be trying to profit from this scam. The medical board didn’t care because I hadn’t seen any patients. But imagine if I did. Imagine I had taken an income from these guys? Fuck.
The FBI can’t touch these guys until they have sufficient evidence. And the crooks would dump the clinics and their “medical director” before any such evidence could be collected. Add to that the FBI agents constantly moving up the ranks and shuffling these cases to new agents, nothing would get done. A team of 4-5 would on average fraud medicare out of $9M-15M a year!
They would be in the US only for a few months and then flee with the money back to Russia.
How do telemedicine scams work? It’s the same, unfortunately. These are run by criminal gangs and they look for and target doctors who are wanting to do multiple telemedicine gigs.
This kind of scam can take all sorts of forms. The entire telemedicine site might be fake with fake visits or they will target states where the physician doesn’t have to talk to the patient over the phone or connect with them on video.
But they can get even more sophisticated. They can have you call a person who pretends to be the patient – always a different phone number. The fake patient on the other line will immediately consent to the treatment and have the doctor prescribe whatever the fuck they were gonna prescribe.
To make this lucrative, this telemedicine scam will focus on specialty care. Think DME’s, expensive medications, expensive referrals. The goal is to make the most amount of money in the least amount of time, dump the website and the doctor like a used condom and move on to another victim.
Are you being scammed?
How can you tell if you are being scammed? Look, you might think you’re clever, but you’re not as clever as these guys. You have no idea if you’re being scammed until it happens to you. And even if everyone will blame you and call you stupid, you were a victim.
There are perfectly legitimate DME companies out there. There are perfectly legit Medicare clinics out there. The problem is that everyone stands to profit from these frauds. The criminal gang profits, the pharmacies profit, the billing companies profit, the telemedicine platforms profit, and even the FBI profits because it’s job security for these guys.
Even the telemedicine company itself can be in on it – you don’t stand a fucking chance. But you best believe that your ass will get investigated and your name dragged through the mud with the best of them.
Just 3 years ago at Kaiser Permanente, we started doing Medicare refresh through the telemedicine platform. This was at the time highly illegal. Medicare mandated that a patient had to be seen in person in order for their Medicare diagnosis to be refreshed and for billing to take place. Did Kaiser know? No idea. Did the doctors do what KP told them to do? Of course.
3 years of dealing with the FBI and the incompetence and lack of regard for my safety was absolutely blatant. As a physician you are nothing to these guys – the criminals and the FBI will use you any way they can to get what they want.
Signs to look for if you are being scammed:
- hard time connecting with the patients
- uncommon medications
- referrals to out-of-network services
- patients who want to get off the phone with you ASAP
- a very high patient volume
- a very fast credentialing process (<2 months)
- few doctors on the platform
- high doctor turnover on the platform
- infrequent communication with leadership
The problem with telemedicine
If you click on a patient and approve 1 medication, how do you know that on the other end the crooks aren’t faking 100 other visits under your name?
Let’s say you deny a specific DME, how do you know whether that order is switched to ‘approved’ behind your back? You don’t. That’s a fact.
There are forensic software detectives who can try to piece together whether such fraud was committed but that only happens on TV. Not only will the criminals get rid of all traces but they won’t even be available for questioning. They’ll change identities, they’ll move to another state and escape jurisdiction.
No prosecutor is gonna get away with indicting a telemedicine company whose owner isn’t even reachable. If they take that case to the DA, the DA will throw it back at them and tell them to go find a doctor to bring in on the case or else no judge will hear the case and no jury will buy it.
We aren’t protected as physicians
One thing I’ve learned about the practice of medicine is that there is a lot of money involved. Money is spent as flagarantly as it is with military defense. Every motherfucker has their hands in the pockets of physicians.
2 of my nurses at Kaiser were stealing my prescription pads, writing for amphetamines, and selling them to their friends. I got questioned about it and Kaiser legal wouldn’t even tell me which nurses were involved!
We are the suckers. We are the drug pushers. We are the ones who will have to do the shittiest work: be the middleman between the customer and the manufacturer.
I had 2 detectives show up to an urgent care in 2008 in Sylmar where I was moonlighting on the weekends. They walk into my clinic during an insanely busy shift and wave a prescription around, asking me what I knew about it…. right, I’ll remember every Vicodin I prescribed. Turns out the guy who got my script died with it in his pocket – he went around and collected some 1,500 pills in one weekend from multiple doctors and dentists and tried to commit suicide. My luck, he didn’t get around to filling mine.
We get bullied. We get lied to. We get fired. We get investigated. We get patient complaints. We get sued. We have our licenses restricted or terminated.
I’m not complaining, not crying here. Never feel sorry for a doctor pulling in $300k a year. I figured the game out relatively early in medicine and started carving my way out of this career. It wasn’t sustainable.
All this said, I’m not saying that the practice of medicine is bad. I’m honored when a friend genuinely comes to me for medical advice or a patient feels heard and taken care of by me. That’s what we all thought of when we imagined practicing medicine. Let me treat patients, give me the benefit of doubt and leave me the fuck alone.
As physicians we have to watch our backs so much that we got no eyeballs on the good stuff. What does every doctor say who gets sued or gets screwed by their medical board? “I had no fucking idea it would be this bad. I never saw it coming. How could this happen to me?”
You have now read my blog. You have read my stories which my employers and medical boards don’t want me to share. And you read the comments of others who have gotten screwed. You are now in the know. Spread the word.
Let’s go into battle, that’s fine, I’ll do that for the sake of patient care. But let’s at least go in knowing what we’re up against. And, for fuck’s sake, if you think this shit is bad then don’t drown in it – start working your way towards financial independence and early retirement.
Is telemedicine dead?
Of course not. This post isn’t meant to make you stop practicing telemedicine. But you have to be aware of potential threats and protect yourself.
You have no idea what goes on behind the scenes after you click send. Companies like Teladoc and Doctor on Demand have zero transparency. At least Teladoc is a public company – they are going to be scrutinized to death.
What about Roman? They prescribe hundreds and thousands of dollars of very expensive ED medications to patients. Is it legit? Will we find out 5 months from now that it was all a big ponzi scheme? What happens to those of us who were seeing patients?
Keep your own notes on suspicious cases and keep your own documents so that you know how many meds you prescribed and what you denied. If your antenna goes up then bail and report it immediately to the proper agencies.
Based on my experience, I would whitelist the following companies and would say you are safe working with these guys:
- Doctor on Demand
- American Well
- Oscar Health
I have experience with them and haven’t had my fraud antenna go up. Then again, I’m the same guy who fell for the Medicare fraud scheme above.