A 48-year-old resident of Mt. Pleasant, South Carolina, has been sentenced to 9 years in federal prison for his involvement in a nearly $100 million health-care fraud scheme.
The scheme centered on the payment of kickbacks and bribes in exchange for unnecessary durable medical equipment (DME) orders, according to an announcement from the U.S. Attorney’s Office for the District of South Carolina. It was uncovered as part of the state’s “Operation Brace Yourself,” a multi-jurisdictional investigation that involved the execution of more than 80 search warrants in 17 federal districts.
The sentencing follows charges brought against Andrew Chmiel in 2019, with evidence presented in court revealing his control and operation of at least 10 DME companies across the United States. These companies were used to submit false claims to Medicare for DME that was not medically necessary and was obtained through illicit means, according to the South Carolina U.S. attorney’s office.
“These DME companies were used by Chmiel and his co-conspirators to submit false and fraudulent claims to Medicare for braces that were not medically necessary and/or were obtained through the payment of kickbacks and bribes,” the announcement states.
The investigation was conducted in collaboration with the Department of Justice’s Criminal Division Fraud Section. The scheme’s complexity included agreements with an offshore call center to purchase completed doctors’ orders, bypassing medical necessity evaluations and exploiting Medicare beneficiaries.
“This offshore call center was advertising through television and internet advertisements,” the announcement continues. “Once a Medicare beneficiary called a 1-800 number that was on the advertisements, that Medicare beneficiary would be screened for eligibility and then convinced that he or she needed a brace, and oftentimes upsold on other braces. The call center would then contact a telemedicine company whose physician and/or nurse practitioner would issue a prescription without regard to the medical necessity.”
During sentencing, Chmiel was also held accountable for obstructing justice by providing false testimony during a trial against a co-conspirator.
“This outcome underscores our unwavering commitment to combat health care fraud and pursue those who exploit Medicare beneficiaries and defraud taxpayers for personal gain,” Tamala E. Miles, special agent in charge at the Department of Health and Human Services Office of Inspector General (HHS-OIG), said in the announcement. “HHS-OIG takes pride in collaborating with our partners to ensure accountability for those seeking to illegitimately profit from federal health care programs.”
Along with the sentence, Chmiel was ordered to pay $98.9 million in restitution.
In addition to Chmiel’s sentence, two corporations involved in the scheme, D.O. Delivery, LLC, and Pain Center LLC, were sentenced to probation and ordered to pay significant restitution.
Chmiel’s sentence serves as a stark reminder of the ongoing efforts to combat health-care fraud and uphold accountability in federal health-care programs.
In its fall 2023 Semiannual Report to Congress, HHS-OIG highlighted more than $3.44 billion in expected recoveries resulting from its audits and investigations conducted during fiscal year 2023.
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