Lawrence Alexander, M.D., a Florida-based orthopedic surgeon, and Dean Zusmer, D.C., a Florida-based chiropractor have been convicted for their roles in a $31 million Medicare fraud scheme.
Ortho Surgeon Convicted in $31 Million Medicare Fraud Scheme
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The scheme involved submitting claims for costly durable medical equipment that was not needed by the beneficiaries. Additionally, the durable medical equipment was acquired through kickback payments.
According to court documents and evidence presented at trial, Dr. Alexander owned one of the four durable medical equipment companies that was involved. He owned the company with another co-conspirator Jeremy Waxman. However, he tried to cover up his and Waxman’s roles in the scheme by putting the company in the name of a family member. Waxman had previously pled guilty for his role in the scheme and was sentenced to over 15 years in prison.
According to the Department of Justice press release, Dr. Alexander was convicted of false statements relating to health care matters. His sentencing is scheduled for April 20, 2023. He faces a maximum sentence of five years in prison.
Zusmer also owned a durable medical equipment company involved in the scheme. Per the Department of Justice press release, collectively the four durable medical equipment companies billed Medicare over $31 million for “medically unnecessary” durable medical equipment. Of that amount, “over $15 million was paid.” The co-conspirators “acquired patient referrals and signed doctors’ orders by paying kickbacks to marketers who used overseas call centers to solicit patients and telemedicine companies to procure prescriptions for unnecessary braces for these patients.”
Zusmer is also scheduled to be sentenced on April 20, 2023. For his role in the scheme, he faces a “maximum penalty of 10 years in prison on each of the following counts: conspiracy to commit health care fraud; health care fraud; and paying illegal health care kickbacks.” He also faces “a maximum penalty of five years in prison for the following counts: conspiracy to pay illegal health care kickbacks and false statements relating to health care matters.”
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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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