Telehealth, Interoperability Recommendations Outlined in Administration’s Health Reform Report

By | December 5, 2018

A New Jersey physician was arrested earlier this month for his role in a telemedicine scheme in which he prescribed expensive compounded medications to patients who did not need them, according to New Jersey U.S. Attorney’s Office.

Bernard Ogon, M.D., a Burlington, N.J. doctor with specialties in family medicine and geriatric medicine, is charged by complaint with one count of conspiracy to commit healthcare fraud, announced U.S. Attorney Craig Carpenito. According to prosecutors, Ogon was paid by five different telemedicine companies to prescribe “exorbitantly expensive compounded medications, such as pain creams, scar creams, migraine creams, and metabolic supplements/’wellness capsules,’ regardless of whether they were medically necessary for the patient.”

The telemedicine companies would send Ogon prescriptions to sign for compounded medications, and Ogon signed the prescriptions without having established any prior doctor-patient relationship, speaking with the patient, or conducting any kind of medical evaluation, according to the state’s attorney’s office.

What’s more, the telemedicine companies often filled out the prescriptions completely—including selecting the compound medications to be prescribed—before Ogon ever saw them. Once Ogon received the filled-out prescriptions, he needed only to sign them to complete the prescription, the attorney’s office explained, adding that Ogon also signed prescriptions for patients residing in states where he was not licensed to practice medicine.

Ogon was paid by the telemedicine companies on a per-prescription basis for many prescriptions he signed. One telemedicine company paid Ogon between $ 20 and $ 30 per prescription. Ogon’s participation in the conspiracy caused a loss to healthcare benefit programs of more than $ 20 million, at least $ 3 million of which was sustained by TRICARE, a healthcare benefit program for members of the military and their families.

The complaint did not name the telemedicine companies specifically, but noted that some of them were located in or around Georgia, Texas, and Florida.

Specifically, according to the complaint, companies marketing various compounded medications for certain pharmacies targeted patients covered under health plans with prescription benefits that paid for the medications. These “marketing companies,” in one way or another, had relationships with pharmacies who were also in on the scheme, while referring beneficiaries to telemedicine companies and their doctors with whom they had financial agreements with. The doctors and the telemedicine companies were being paid by these marketing companies to authorize the prescriptions, meaning they did not have to bill the health plans for their services, according to the complaint.

One example of overcharging patients in this fraudulent scheme, as per outlined in the complaint, was in 2015 when an individual, 86 years old, was prescribed two pain creams, each with six refills, and was charged more than $ 4,500. This patient did have scars but was not experiencing pain, according to his intake forms.

A separate patient, 82 years old, also with scars but no reporting of pain, was prescribed one pain cream and wellness capsules, each with six refills, and was charged more than $ 7,600.

The charge of conspiracy to commit healthcare fraud is punishable by a maximum of 10 years in prison and a fine of $ 250,000 fine, or twice the gross gain or loss from the offense, according to the attorney’s office.

Last month, four individuals and seven companies, including telemedicine company HealthRight LLC, were indicted in a $ 1 billion healthcare fraud scheme.

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