December 9, 2021 Fraud & Scams
Wisconsin Doctor Guilty of Fraud
The case involves a doctor, Ravi Murali, formerly from the Edgerton area, who was sentenced in November for his role in a scheme to defraud Medicare. He was sentenced to 4½ years in federal prison and required to make full restitution of the amounts he earned from this scam. He wrote thousands of fraudulent orders, falsifying medical records, and signing orders for unneeded durable medical equipment (DME) billed to Medicare. Other participants in the scheme used his fraudulent orders to bill Medicare $26 million, of which Medicare paid $13 million. Click here to read more.
The Wisconsin Senior Medicare Patrol was instrumental in helping to identify, track, and document this Medicare fraud scheme. We covered this case in two articles which appeared in the SMP SCOOP newsletter. These two articles are provided below.
The First Article Appeared in the September 2021 Issue of SCOOP:
Senior Medicare Patrol at Work!
By Ingrid Kundinger, SMP Project Manager
The Wisconsin Senior Medicare Patrol receives phone calls on an almost daily basis about unwanted medical braces that are sent to Medicare beneficiaries. In some of these cases, Medicare Summary Notices indicate that an unknown medical equipment supplier and health care provider have not only signed orders for this unwanted equipment but submitted claims to Medicare for payment. When all these pieces come together, and with permission from the impacted Medicare beneficiary, the Senior Medicare Patrol gets to work submitting all this information to the federal Office of Inspector General for investigation. The story below is an example of how important reporting is, as a fraudulent doctor from Wisconsin was investigated and subsequently convicted for his role in a Medicare scam. Right here in our state, Medicare beneficiaries were victims of fraud. The bottom line is this: EVERYONE has a role to play in detecting fraud, reporting it, and thereby protecting the integrity of the Medicare program.
Doctor Pleads Guilty to Taking Part in Medicare Fraud Scheme
Ed Treleven | Wisconsin State Journal Mar 31, 2021
Reprinted with the permission from the Wisconsin State Journal
An Edgerton doctor pleaded guilty Wednesday to federal health care fraud for his role in a multimillion-dollar scheme to defraud Medicare by placing orders for unnecessary medical braces.
Dr. Ravi Murali, 39, pleaded guilty to one of the 12 counts he originally faced under an indictment that was issued in June.
“I prescribed the braces without following (the) procedure of examining and calling the patients,” Murali told U.S. District Judge James Peterson. “That led to unnecessary Medicare billing.”
“Not only unnecessary but you knew it was deceptive and fraudulent, correct?” Peterson asked.
“Yes,” Murali responded.
Asked about the purpose for his actions, Murali responded, “I was just trying to get by.”
Murali now faces up to 10 years in prison when he is sentenced in August, but before then it’s anticipated that Murali will provide information helpful to prosecutors who are looking to charge others involved in the scheme. That cooperation, according to terms of a written plea agreement, could prompt prosecutors to ask for a sentence that reflects his help.
Assistant U.S. Attorney Zachary Corey said in court Wednesday that talks have already begun involving investigations into telemedicine companies elsewhere in the U.S.
Peterson warned Murali, however, that the decision to ask for sentencing consideration is up to prosecutors, and ultimately it’s up to Peterson to sentence Murali accordingly.
The indictment states that the scheme fraudulently billed Medicare for more than $26 million, of which Medicare paid $13 million.
From January 2017 to January 2020, the indictment states, while Murali was working as a physician for various telemedicine companies, he signed orders for medical braces for ankles, knees, backs, shoulders, wrists, and hands for Medicare beneficiaries that contained false statements.
Murali ordered braces for Medicare recipients regardless of need, and when Medicare was billed, Murali received $30 for each telemedicine consult he completed, the indictment states.
The Second Article Appeared in the December 2021 Issue of SCOOP:
Investigated, Guilty, & Sentenced.
By the Wisconsin SMP Team
Edgerton doctor who pleaded guilty to defrauding Medicare has been sentenced to 54 months in a federal prison.
In the September issue of the Scoop, the SMP team brought you the story of a doctor, Dr. Ravi Murali, formerly from Edgerton, Wisconsin, who pleaded guilty for his role to defraud Medicare. The multi-million scheme involved falsifying medical records and placing orders for medical braces that were unnecessary and for not following prescribed protocols. The case states that Medicare was billed $26 million, of which Medicare paid $13 million.
The investigation spanned from January 2017 to January 2020, in March 2021 he pled guilty, and in November he was sentenced to over four years in a federal prison.
The Senior Medicare Patrol played a vital role in bringing this doctor to justice. Medicare beneficiaries had contacted SMP to report their concerns of charges of unwanted braces showing up on their summary statements. With the permission of the beneficiary, the information was identified and documented then submitted to the Department of Health and Human Services Office of Inspector General for investigation. This case demonstrates the importance of reviewing your medical statements and following up on any questions or suspicions you may have. Everyone has a role in detecting fraud and reporting it. SMP is here to help.