A 69-year-old Asian doctor named Le Thu, from Boston, has pleaded guilty last Friday to a healthcare fraud case involving tens of millions of dollars. She faces two charges related to healthcare fraud, accused of charging health insurance companies for genetic testing services that she never actually provided.
According to the allegations, from March 2017 to November 2020, Le Thu knowingly and actively participated in a fraudulent healthcare insurance scheme by submitting false orders for genetic testing services that were never actually provided in order to defraud insurance funds. She either personally or instructed individuals without medical training to forge medical documents, claiming to have met with patients, conducted examinations, and obtained consent, making the tests appear necessary and compliant.
In reality, Le Thu did not have any contact with any patients involved in the fraudulent orders or provide any medical services. For example, in one forged genetic testing order, she claimed that the test results would “assist in making clinical decisions,” ultimately resulting in a third-party laboratory billing Medicare around $5,368, with Medicare paying approximately $2,886. Another false order led to over $24,000 in reimbursements.
Overall, through the submission of false medical orders, Le Thu caused laboratories to submit reimbursement claims totaling around $35.3 million to Medicare, of which Medicare ultimately paid about $25.3 million. Each charge of making false statements related to healthcare can carry a maximum sentence of five years in prison, three years of supervised release, and a fine of $250,000 or double the total economic loss caused by the crime (whichever is higher).
Furthermore, in December 2021, Le Thu was already involved in another case of international telemedicine healthcare fraud and kickbacks. According to the statements of the Acting Attorney General of New Jersey at the time, the case involved a plan that extensively prescribed compounded drugs and durable medical equipment (DME) through a telemedicine company without considering medical necessity and promoted this behavior through kickback payments. The individuals involved included Le Thu and three “senior” employees of a telemedicine company.
Le Thu would charge approximately $35 for each prescription without having any contact with the patients.
The fraud scheme included the employment of “nurses” based in the Philippines without valid U.S. practice credentials, falsifying patient records, and then submitting claims to TRICARE, Medicare, and private insurance companies, resulting in total losses of approximately $37 million.
In order to encourage healthcare providers to issue prescriptions without establishing doctor-patient relationships, the two individuals involved falsely informed healthcare providers that the “nurses” had counseled patients, collected medical histories, and determined the appropriateness of dispensing drugs or DME in medical terms.
In reality, these “nurses” were in the Philippines, not licensed to practice in the United States, and usually didn’t speak with the patients. Marketing company representatives provided patient information to the telemedicine company and paid fees in exchange for prescriptions for compounded drugs and DME.