Kickback Fraud Exploited COVID-19 Medicare Telehealth Policies

A Florida man has pleaded guilty to a kickback conspiracy that exploited temporary COVID-19 Medicare telehealth policies meant to increase access to care for Medicare beneficiaries.

Co-owner of Panda Conservation Group LLC, Leonel Palatnik made illegal payments to Michael Stein, owner of 1523 Holdings LLC. In exchange, Stein directed telehealth providers to refer Medicare beneficiaries to Panda’s laboratories for genetic testing.

The telehealth providers agreed to authorize expensive and unnecessary cancer and cardiovascular tests because Stein offered them access to Medicare beneficiaries whom they could bill for consultations. Palatnik and Stein capitalized on policies that temporarily expanded telehealth coverage for Medicare beneficiaries during the COVID-19 pandemic.

Stein, Palatnik, and other Panda Conservation Group owners covered up the $73 million conspiracy scheme with a sham contract for alleged IT and consultation services, according to the Department of Justice news release.

The Department of Health and Human Services Office of the Inspector General (HHS-OIG) is investigating the case with the FBI’s Miami and Dallas Field Offices and the Healthcare Rapid Response Team.

Palatnik pleaded guilty to one count of conspiracy to offer kickbacks and one count of paying a kickback. He will receive sentencing from a federal district court judge on November 9, 2021 and faces a maximum penalty of 15 years in prison.

Attorney General Merrick Garland established the COVID-19 Fraud Enforcement Task Force in mid-May 2021 to direct DOJ resources toward preventing pandemic-related fraud. The telehealth kickback case was a part of a coordinated law enforcement action that took on 14 pandemic-related cases on May 26.

“The law enforcement action was brought in coordination with the Health Care Fraud Unit’s COVID-19 Interagency Working Group, which is chaired by the National Rapid Response Strike Force and organizes efforts to address illegal activity involving healthcare programs during the pandemic,” the news release stated.

Telehealth advocates were vocal about the schemes being more closely aligned with telefraud, which they claim are investigations of traditional fraud masquerading as telehealth, rather than telehealth coverage.

Early on in the pandemic, the Coronavirus Aid, Relief, and Economic Security (CARES) Act introduced expanded Medicare coverage for telehealth services. These temporary policies included coverage for audio-only telehealth visits and relaxed the requirement that a provider must have seen a patient in person within the past three years.

Many provider organizations are pushing for permanent telehealth coverage once the nation moves past the pandemic. Palatnik’s actions, which exploited these policies, may hurt this initiative.

However, there had been instances of Medicare fraud from telehealth providers even before the COVID-19 pandemic.

In April 2019, five telemedicine companies were allegedly part of a scheme in which healthcare providers and an international call center convinced Medicare beneficiaries that they needed durable medical equipment (DME), regardless of medical necessity. The call center allegedly paid kickbacks to the telemedicine companies to obtain the DME orders for the beneficiaries.

CMS is working with the HHS-OIG to increase accountability and reduce the presence of fraudulent providers, the DOJ news release concluded.