What is the sentence for 10 counts of health care fraud?
Ortho Surgeon Receives 16 Month Prison Sentence
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Secondary#departmentofjustice#opioidprescriptions
If you are orthopedic surgeon Olarewaju James Oladipo, M.D., the sentence is 16 months in prison followed by an additional one year of supervised release.
U.S. District Court Judge Allison D. Burroughs issued the sentence to the Massachusetts-based surgeon following his December 2023 conviction by a federal jury. For OTW’s original coverage of the health care fraud case, see “Orthopedic Surgeon Convicted in Opioid Health Care Fraud Case.”
Dr. Oladipo’s conviction comes after a nearly four-year long health care fraud scheme, during which he was also one of the top opioid prescribers in Massachusetts. The scheme to falsely billed for patient visits by using billing codes for more expensive procedures that were not actually provided ran from January 2016 through December 2019.
According to the Department of Justice (DOJ) press release, during that four-year period, Dr. Oladipo “frequently billed for more than 60 patients per day and sometimes more than 100 patients per day.” If Dr. Oladipo was seeing that number of patients, then the visits “could have only lasted five minutes or less.” However, Dr. Oladipo’s billing codes tended to correspond to visits that were much longer durations, even as long as 45 minutes.
How could Dr. Oladipo ensure that patients would continue to frequent his practice? According to the DOJ, “Dr. Oladipo ensured this high flow of patients to his practice by prescribing powerful, highly addictive opioids at a rate that made him one of the top prescribers of such drugs in Massachusetts.”
The sentence is based upon the U.S. Sentencing Guidelines and related statutes. However, the 16-month prison sentence is not the maximum sentence. According to a previous Department of Justice press release, the charges of health care fraud and conspiracy to commit health care fraud “each provide for a sentence of up to 10 years in prison, one year of supervised release and a fine of up to $250,000.”
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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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