Becker's ASC Review

41 HEALTHCARE NEWS Massachusetts physician indicted in $37M telemedicine kickback scheme By Jackie Drees A Massachusetts physician and three others have been indicted in an alleged seven-year, $37 million telemedicine fraud and kickback scheme, the Justice Department said Dec. 10. David Woroboff, George Willard and Randall Mills, all former high-level employees of a telemedicine company, and physician Le u, MD, are each being charged with one count of conspiracy to commit healthcare fraud and one count of conspiracy to violate the federal Anti-Kickback Statute for allegedly operating a scheme that caused multimil- lion-dollar losses to Medicare, Tricare and private insurers. In 2014, the three executives allegedly began to use their company and its associated pro- viders to write prescriptions for compound- ed medications and durable medical equip- ment that were not medically necessary for patients. Providers then received kickback payments, the Justice Department alleges. Providers who participated in the alleged scheme wrote prescriptions for patients without having an established provider- patient relationship, in violation of certain state telemedicine laws. Mr. Woroboff, Mr. Willard and Mr. Mills allegedly agreed to pay Dr. u about $35 per prescription, and Dr. u wrote prescriptions without speaking to patients in exchange for the payments, ac- cording to the indictment. Mr. Mills and Mr. Woroboff allegedly falsely told providers that nurses had already consulted with the patients, taken their medical histories and determined that the compounded medication or medical equip- ment were appropriate treatment plans, the Justice Department said. However, the nurses were located in the Philippines, were not registered to practice medicine in the U.S. and usually did not speak with patients, the indictment alleges. e Justice Department alleges that the telemedicine company executives were able to get patient information through represen- tatives of marketing companies that paid the telemedicine company to generate prescrip- tions for compounded medications and durable medical equipment. n Physicians in hospital- owned practices often earn less than those who are independent, study finds By Marissa Plescia P hysician-owned practices acquired by hospitals from 2014- 18 led to those physicians earning income that was 0.8 percent lower on average than those who remained inde- pendent, a December Health Affairs study found. The study examined survey data on physician practice ownership and physician compensation data between 2014 and 2018. During this time frame, there was an 89.2 percent increase in hos- pital or health system ownership of physician practices, according to the report. Among physicians overall, there was a $2,987 decrease in annual income on average. Nonsurgical specialists saw their income drop by 2.4 percent, or $9,652 per year. Primary care physicians experienced a 1.2 percent increase in compensation, or $3,179 annually. Surgical specialists, meanwhile, saw a 2.1 percent in- crease, or $10,741 per year. Physician practices acquired by hospitals also on average had lower Medicare billing than those that are independent, of $109,795 compared with $221,626. Physicians who were inde- pendent also practiced for about two more years and worked about three fewer hours per week on average. n CVS Health wants to add specialty services, buy more primary care groups By Laura Dyrda C VS Health is planning to acquire more pri- mary care practices in the coming year and eventually expand specialty services at its clinics, Alan Lotvin, MD, CVS Health executive vice president and president of CVS Caremark, said during a Dec. 9 investor's call. CVS Health is pivoting its focus at retail stores to advanced primary care centers, enhanced Health- HUB locations and CVS Pharmacy stores. While the company announced last month it plans to close 900 stores in the next three years to reduce density, it will also take a digital-first approach with its 35 million online members. CVS Health now has more than 40,000 physi- cians, pharmacists, nurses and nurse practitioners in its network. With its new growth strategy, Dr. Lotvin said the company wants to go from delivering episodic care to longitudinal care and provide "everything you would see in a doctor's office." n

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