Background
Dr. David Young, a physician in Texas, was convicted of conspiracy to commit health care fraud and making false statements. He worked for telehealth companies that billed Medicare for durable medical equipment and genetic tests. The government alleged that Dr. Young signed prescriptions for thousands of patients without examining them, relying on pre-filled data from the companies.
The court’s reasoning
The court reviewed the sufficiency of the evidence de novo, finding that a rational jury could conclude Dr. Young knew the unlawful purpose of the agreement. The evidence showed he signed prescriptions at speeds inconsistent with patient exams, provided login credentials to non-medical staff, and continued signing despite red flags. The court rejected the venue challenge as waived due to untimely objection. Regarding sentencing, the court held that the billed amount was prima facie evidence of intended loss under the Sentencing Guidelines.
The fraud is the false certification of patients as needing DME or genetic tests.
United States v. Little, No. 21-11225, 2023 WL 7294199, at *3 (5th Cir. Nov. 3, 2023)
What it means going forward
The decision reinforces that physicians can be held criminally liable for health care fraud even if they claim ignorance of billing details, provided they knowingly lent their credentials to a fraudulent scheme.