Latest News on the Medicare Advantage Program

Two Florida doctors guilty of $31 million scheme to bill Medicare for unnecessary equipment

Justice Department attorneys said the DME network of companies depended on marketing companies that recruited Medicare patients and received kickbacks in an elaborate telemedicine racket. Medicare, the federal insurance program for the elderly, paid a total of $15 million based on the four companies’ fraudulent claims for orthotics, jurors found after a two-week trial.

The DME scheme was reminiscent of Medicare fraud in South Florida in the 1990s before it spread to other areas of medicine, including physical therapy, diabetes shots and mental health services.

Both Alexander and Zusmer, who are free on bond, face prison terms at their April 20 sentencing before U.S. District Judge K. Michael Moore. Alexander is expected to receive far less prison time than Zusmer. Regardless of their punishment, both defendants plan to appeal the jury’s guilty verdicts.

According to trial evidence, Zusmer collaborated with Waxman by jointly owning and operating Active Assist DME in Pinellas County.

Justice Department attorneys said Zusmer and Waxman obtained patient referrals and orders signed by doctors by paying kickbacks to marketing companies that used overseas call centers to solicit patients. They also paid kickbacks to telemedicine companies that obtained prescriptions from doctors for unnecessary orthotics. According to federal agents from the FBI and the Office of Health and Human Services of the Inspector General, the devices were allegedly needed for injuries to the knee, back, shoulder and wrist.

Zusmer, who had his chiropractic practice in Miami Lakes, was convicted of conspiracy to commit health care fraud, health care fraud, conspiracy to pay illegal health care fees, pay illegal health kickbacks and making false statements related to matters sanitary But he was also found not guilty of two anti-bribery charges.

One of his defense attorneys, Barry Wax, said the trial hinged on the testimony of the government’s main witness: Waxman.

“We are very surprised and disappointed with the jury’s verdict,” Wax told the Miami Herald Tuesday. “This case had a significant amount of reasonable doubt, based primarily on the testimony of one of the co-defendants, Jeremy Waxman. We expected a very different verdict.”

Trial evidence also showed that Alexander hid both his role and Waxman’s in the scheme by putting his company DME in the name of one of Alexander’s family members, Justice Department attorneys said. The company was called Silent Hill Bracing and Orthopedic Supplies, located in Bay Harbor Islands. Court records show Alexander’s mother is listed as the owner of the business on the 2019 Medicare application enrollment form, which she signed in 2019.

Alexander, who had his medical practice in Hialeah, was convicted of making false statements related to health matters. But he was acquitted of the more serious charge of conspiring to defraud Medicare by paying illegal health care fees.

Alexander’s defense attorneys, Jose Quinon and Frank Quintero, disputed the jury’s only guilty verdict and plan to appeal.

“There was no evidence to convict Dr. Alexander,” Quintero said.

He said Alexander was not involved in running the DME company, Silent Hill; did not fill out the Medicare enrollment application and that his mother’s signature was forged on the form, which provides details about the company’s services, including a change in its hours of operation. He added that Waxman was managing Silent Hill, not Alexander.

During his testimony at trial, Waxman said he and his staff filled out the Medicare enrollment application for Silent Hill and routinely would have shown it to Alexander. But he also said he couldn’t remember if he did in this case.

Waxman testified that the initial signature on the form belonged to Alexander’s mother. But he further testified that the second signature on the form also belonged to Alexander’s mother, along with her fingerprints. He later admitted under oath that the two signatures did not match.

When Alexander’s defense attorney, Quinon, accused him of “forging signatures” on the form, Waxman stated, “Never without Dr. Alexander’s direction. Not once.”

“We have to take your word for it, right?” Quinon said.

“At this very moment, yes,” Waxman said. “There is also evidence to support that.”

Waxman, who pleaded guilty to conspiracy to commit health care fraud and wire fraud, was sentenced before trial to more than 15 years in prison. But he is expected to receive a reduction for his cooperation as a witness against Alexander and Zusmer.

Ronald Davidovic, owner of a Broward marketing company, also pleaded guilty to conspiracy to commit health care fraud. He was sentenced to almost six years.

Comments are closed.