The United States Department of Justice has announced an indictment charging Elemer Raffai, M.D., an orthopedic surgeon based in Malone, New York, with health care fraud.
Indictment Charges NY Ortho Surgeon in Health Care Fraud Scheme
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According to the federal indictment that was unsealed earlier this month, Dr. Raffai purportedly participated in a health care fraud scheme. Per the indictment, Dr. Raffai claimed to practice telemedicine with the AffordADoc Network. The telemedicine companies allegedly paid Dr. Raffai for consultations. According to the indictment, the AffordADoc Network supposedly included the following Delaware-based companies: PCS CC, LLC, which also did business as Procall; Telehealth Doctor’s Network LLC, which also did business as Video Doctor USA; and Telemed Health Group LLC, which also did business as AffordADoc.
From July 2016 through June 2017, per the indictment, Dr. Raffai supposedly “signed and authorized prescriptions and order forms for braces and other items: (a) that were not medically necessary; (b) for beneficiaries he had not physically examined and evaluated; (c) based solely on a short telephonic conversation; and (d) that were induced, in part, by the payment of bribes and kickbacks.”
The indictment argues that instead of paying Dr. Raffai for the consultations, he was actually paid for “prescribing and ordering DME [durable medical equipment] and prescription drugs, such as braces and other items.” He was purportedly paid $25 or $30 per patient consultation by telemedicine companies. From July 2016 through June 2017, this allegedly amounted to $176,000 in payments from the AffordADoc Network.
The indictment also claims that Dr. Raffai, “together with others, submitted and caused to be submitted approximately $10 million in false and fraudulent claims to Medicare for braces” and Medicare paid more than “$4 million on those claims.”
In the press release, United States Attorney for the Eastern District of New York Breon Peace stated, in part, “In exchange for kickbacks from telemedicine companies, Dr. Raffai allegedly submitted millions of dollars in false and fraudulent claims to Medicare on behalf of beneficiaries without even examining them or based on conversations on the phone that lasted less than three minutes.”
Dr. Raffai was arrested earlier this month. According to the press release, Dr. Raffai faces up to 10 years in prison.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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