NY Doctor Charged in $10M Medicare Fraud

A doctor in New York state has been indicted in an alleged $10 million Medicare/Medicaid fraud scheme, the U.S. Department of Justice said Thursday (April 21).

According to a Justice Department news release, Elemer Raffai, 56, of Rome, is accused of signing prescriptions and order forms using telemedicine services to procure durable medical equipment (DME) that was not medically necessary.

The department said Raffai allegedly caused these claims — made between 2016 and 2017 — to be submitted “based solely on a short telephone conversation for beneficiaries he did not physically examine and evaluate and that were induced, in part, by the payments of bribes and kickbacks to Raffai.”

In addition, the indictment against Raffai alleges he and others made about $10 million in false and fraudulent claims to Medicare for DME, and Medicare paid more than $4 million on those claims.

Raffai is charged with health care fraud and was set to make his first court appearance in the U.S. District Court for the Northern District of New York on Thursday. He could not be reached for comment Thursday and it wasn’t clear if he had an attorney. If convicted, Raffai faces a maximum total penalty of 10 years in prison, the Justice Department said.

Learn more: Feds Charge 20 in Alleged $150M COVID Fraud Schemes

These charges come amid a wave of prosecutions against people in the medical field accused of carrying out a range of scams that are connected to the COVID pandemic and that totaled $150 million in improper government payments.

As PYMNTS reported earlier this week, the charges — against 20 different people — come as Justice Department is stepping up its effort to uncover thefts from programs that contributed billions to the healthcare system during the pandemic.

These schemes “involve extraordinary efforts to prosecute some of the largest and most wide-ranging pandemic frauds detected to date,” said Kevin Chambers, who is leading the federal government’s COVID fraud enforcement efforts.