Kansas Doctor Charged in Telehealth Fraud Scheme

The United States Department of Justice (DOJ) announced that Dr. Gautam Jayaswal of Overland Park, Kansas, faced charges following a telehealth fraud scheme involving accusations of ordering unneeded tests and equipment for a large patient population.

Jayaswal, who works mainly as an emergency room physician, faced these charges in a US District Court in St. Louis early this week. While pleading guilty, Jayaswal admitted to ordering unneeded genetic tests and orthotic braces for thousands of patients.

These actions mainly took place between 2017 and 2021 as Jayaswal contracted with various companies such as Barton & Associates, DialCare Co, and Doctegrity. After ordering equipment for 1,433 patients, these companies then obtained $1.36 million from Medicare. Additionally, Jayaswal signing orders for unnecessary tests on behalf of 2,061 patients led to Medicare Part B paying about $14.7 million.

The penalties that Jayaswal may face as a result of these actions may include five years in prison or a $250,000 fine, among the reimbursement requirements.

Cases such as this are common and have marginally grown since the onset of the COVID-19 pandemic.

In April 2022, for example, the DOJ shared that orthopedic surgeon Elemer Raffai, MD, faced charges amid a telehealth fraud scheme. Raffai signed prescriptions and order forms through alleged telemedicine services to obtain unnecessary medical equipment, per the indictment. Raffai also faced accusations of submitting claims based on short telephone conversations with patients he had yet to examine.  

As a result of cases involving telehealth fraud, efforts surrounding their elimination become increasingly apparent.

While acknowledging the high level of resourcefulness associated with telehealth, the Healthcare Fraud Prevention Partnership (HFPP) noted its dangers. Before the onset of the COVID-19 pandemic, policies surrounding telehealth use were stricter. The HHFP also noted that, although telehealth flexibilities enacted in March 2020 led to further ease in assisting many patients, antagonists who participate in fraudulent actions exist.

Despite progressive Federal and State actions that aim to diminish these issues, a white paper from the HFPP and the Stanford University School of Medicine titled “Exploring Fraud, Waste, and Abuse Within Telehealth” took its own approach.

The paper described common telehealth fraud behaviors such as billing for unnecessary services, upcoding, utilization of invalid time-based codes, and false labeling of virtual COVID-19 care to promote payments.

The HFPP then provided various strategies to alleviate these issues, such as the use of data analytics and machine learning to enhance detection, promoting awareness of common issues among patients and providers, and forming collaborations between healthcare organizations.