November 2011

Wisconsin Medicaid, Medicare fraud cases focus on orthotic device sales

Recent legal actions in Wisconsin have targeted millions of dollars in Medicare and Medicaid fraud associated with the sales of orthotic devices.

On October 24 Wisconsin Attorney General J.B. Van Hollen announced that his office had charged seven Milwaukee residents with 70 counts of Medicaid fraud and 50 counts of identity theft related to payment of claims for durable medical equipment (DME).  The complaints allege defendants submitted more than $1.2 million in fraudulent claims for knee-ankle-foot orthoses and other DME.

The sale of DME is typically followed by a trail of complementary claims from hospitals or physicians. Claims for the devices in question were never filed and the investigation showed the recipients of record didn’t have a need for the devices and didn’t know the putative providers.

On September 16 another case of orthotic-related fraud in Wisconsin appeared to reach its resolution when Rickey Kanter, founder and former CEO of Mequon-based Dr. Comfort, was fined $50,000 and sentenced to a year and a day in federal prison for mail fraud related to improper Medicare reimbursements in 2006. This sentence comes five months after Kanter pled guilty to the fraud charges and agreed to pay a $27 million civil settlement.

According to the U.S. attorney general’s office, Kanter knowingly sold diabetic shoe inserts that failed to conform to Medicare requirements. As part of his plea deal Kanter is barred from participating in any federal healthcare programs for 15 years. Dr. Comfort was sold in March to California-based supplier DJO Global, which paid $254.6 million for the company and agreed to sign a corporate integrity agreement with the Department of Health and Human Services Office of Inspector General.

Leave a Reply

Your email address will not be published.

This site uses Akismet to reduce spam. Learn how your comment data is processed.