Rochester doctor sued for $3.4M Medicare fraud scheme

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The U.S. attorney’s office is suing a Rochester-area doctor for his alleged involvement in fraudulent Medicare claims totaling $3.4 million, while he allegedly received kickbacks of $88,000 for signing the claims.

The civil action was filed Monday in U.S. District Court against Dr. Enaame Farrell to recover statutory damages and civil penalties under the False Claims Act (FCA).

The complaint alleges that, from May 2020 through April 2021, Farrell “knowingly caused false or fraudulent claims for payment to be submitted to Medicare, for medications, diagnostic testing, and durable medical equipment.”

The claims were not supported by the patients’ medical records, there was no bona fide patient relationship or patient encounter with Farrell, and Farrell “knowingly and willfully solicited and received kickbacks for the orders,” the suit claims

Farrell is accused of false claims for more than 2,000 Medicare beneficiaries, for which Medicare paid $3,394,811.61, according to the complaint.

Under the FCA, Farrell could be liable for three times the amount of damages sustained by the government, plus a civil penalty per violation.

The civil penalty amounts range from a minimum of $14,308 to a maximum of $28,618, according to the complaint.

“Dr. Farrell engaged in a scheme to defraud Medicare by ordering unnecessary and unwanted items and services for Medicare beneficiaries,” the complaint states.

According to the complaint, Farrell was paid between $13 and $19 for each medical order he signed for patients he never met or examined.

“In total, Dr. Farrell received payment of approximately $88,000 for the orders he signed for items and services,” according to the complaint.

Farrell had contracted with a temporary staffing company. Under the agreement, Farrell was assigned to clients to perform duties as a temporary medical practitioner.

Farrell was assigned to perform “chart reviews.” Farrell was sent prepopulated patient files, which included orders for items and services, through email or an online portal.

If Farrell determined the orders were reasonable and necessary, and the patient was eligible to receive them, he would electronically sign the order and return it by email or through an online portal.

The signed orders would then be sent to billing entities, who relied on the orders to provide the items and services to Medicare beneficiaries, and to submit claims for the items and services to Medicare.

“Dr. Farrell’s certifications were false and fraudulent because he did not and could not have certified that the items and services he ordered were reasonable and necessary because, among other reasons, he did not personally assess or examine the patients or even review the patient files,” according to the claim.

Medicare will not pay for certain durable medical equipment (DME), such as knee braces without documentation that a joint laxity test was performed on the patient. Farrell did not perform joint laxity tests for more than 900 patients for whom he ordered knee braces, according to the complaint.

And Farrell did not confirm that any such joint laxity tests occurred, despite his false representations that such tests were performed, the suit claims.

A joint laxity test, like those required to order knee braces, cannot be performed over the phone or remotely, let alone by a person with no medical training.

Patients who were ordered knee braces by Farrell confirmed that they were not examined by Farrell, or any other provider, and that no joint laxity test was performed on them.

Farrell ordered knee braces for one patient who had had her legs amputated. Medicare paid more than $1,200 for the braces.

Farrell ordered DME for more than 1,600 Medicare beneficiaries, and Medicare paid for DME for more than 1,250 of those beneficiaries at a cost of more than $1.8 million.

In one case, Farrell signed orders for medications, and certified that the medications were reasonable and necessary, for one patient less than three minutes after the previous order he signed.

In that time, Farrell purported to have reviewed (the patient’s) file and ordered 15 different medications and other items.

He ordered medications for more than 600 Medicare beneficiaries, for which Medicare paid about $1.45 million, according to the complaint.

“Dr. Farrell electronically signed orders often within seconds of accessing the patient file, even though some patient files were many pages long and contained multiple orders — each requiring a separate assessment of medical necessity,” the complaint states.

“As a result of Dr. Farrell being paid to sign orders, the billing entities submitted over 9,000 claims to Medicare for items and services that were tainted by kickbacks. Medicare paid approximately $3.4 million for these items and services,” according to the complaint.

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