Introduction

In a significant development in healthcare compliance, a federal jury in Nashville has convicted Dr. Benjamin T. Toh, a 68-year-old physician from Chicago, Illinois, for his involvement in a $9.5 million healthcare fraud conspiracy. This case highlights the serious legal ramifications for healthcare providers who violate federal Anti-Kickback Statute. Let’s delve deeper into the case and what it implies for healthcare compliance moving forward.

The Conviction

Announced by United States Attorney Henry C. Leventis for the Middle District of Tennessee, Dr. Toh was indicted by a federal grand jury in December 2022 and recently convicted of conspiracy to violate the federal Anti-Kickback Statute following a two-week trial.

According to trial evidence, Dr. Toh collaborated with supposed telemedicine companies to gain access to Medicare and Medicaid patients nationwide. From March 2019 to September 2019, Dr. Toh and his co-conspirators submitted fraudulent claims exceeding $9.5 million for cancer genetic tests. Notably, these orders were placed without any direct consultation with the patients—neither in person nor via telemedicine—and without reviewing test results.

The Kickback Scheme

The fraud deepens as the telemedicine companies, in return for Dr. Toh’s signed orders, paid him kickbacks. These telemedicine companies received payments from marketing firms that targeted Medicare and Medicaid recipients in various settings, like senior fairs and nursing homes, to obtain their genetic material via mouth swab kits. The swab kits were then sent to a lab in Spring Hill, Tennessee, which conducted the tests and subsequently billed Medicare and Medicaid.

Legal Ramifications and Penalties

Based on the conviction, Dr. Toh faces up to 5 years in prison and a fine of $250,000. He is scheduled for sentencing on January 9, 2024. U.S. Attorney Henry C. Leventis emphasized that this case serves as a “powerful reminder that healthcare providers” who engage in fraudulent practices “will be held accountable.”

Implications for Healthcare Compliance

Increased Scrutiny

The case serves as a stark reminder that regulatory authorities are actively scrutinizing partnerships between healthcare providers and third-party companies.

Importance of Due Diligence

Healthcare providers must conduct thorough due diligence before entering into partnerships with telemedicine or marketing companies.

Reinforcing Best Practices

Compliance programs should continually be updated to meet the challenges posed by new healthcare delivery models like telemedicine.

Conclusion

The conviction of Dr. Benjamin T. Toh is a noteworthy event in the realm of healthcare compliance, especially concerning the federal Anti-Kickback Statute. It underscores the necessity for healthcare providers to exercise extreme caution in their dealings, particularly with telemedicine and marketing companies, to ensure full compliance with federal laws and regulations.

For legal advice tailored to your specific circumstances, it is always advisable to consult with a healthcare compliance attorney.