An Ohio doctor has pleaded guilty after being charged with participating in a healthcare fraud conspiracy that resulted in over $14.5 million in false Medicare claims.
Timothy Sutton, a 43-year-old North Ridgeville physician, was involved in a scam in which he issued unnecessary medical orders and then billed them to Medicare, a federal health benefits program primarily for the elderly.
Sutton’s admission occurred as part of a larger investigation involving two telemedicine companies and fraudulent practices in Ohio and Florida.
According to a press release from the Northern District of Ohio US Attorney’s Office, Sutton was affiliated with Nevada’s Real Time Physicians, LLC and Florida’s 24 Hour Virtual MD, LLC.
These companies provided pre-completed orders for durable medical equipment (DME) and cancer genetic testing (CGX), which Sutton was expected to review and approve.
According to documents, Sutton claimed to have examined patients using telemedicine to justify the need for these services; however, no such examinations occurred. This revelation has now cast doubt on the legitimacy of telemedicine, particularly in the context of Medicare services.
The conspiracy did not end with the fraudulent prescriptions. After Sutton approved the equipment and testing, the telemedicine companies could either fulfill the orders themselves or sell them to other organizations.
The orders, which were issued without proper medical justification, violated Medicare regulations and federal laws, essentially siphoning funds from the healthcare system.
Sutton’s plea last Friday included charges of attempted and conspiracy to commit wire and bank fraud, false statements regarding health care matters, and aggravated identity theft.
The severity of these charges could result in him serving up to 27 years in prison, with a sentencing hearing set for July 26. A federal district court judge will then decide the sentence based on the United States Sentencing Guidelines and other statutory factors.
The investigation that led to Sutton’s guilty plea was a collaborative effort between the Health and Human Services Office of Inspector General and the FBI Cleveland Division.
With Assistant U.S. Attorneys Om Kakani and Rebecca Lutzko prosecuting the case, Sutton’s guilty plea is a significant step forward in the ongoing fight against healthcare fraud.
