Georgia man sentenced to seven years and ordered to repay $27.9 million after a federal case found he ran a telemedicine scheme that generated more than $56 million in false Medicare claims for orthotic braces.
The owner of two telemedicine businesses was sentenced to seven years in prison and ordered to pay $27.9 million in restitution for his role in a fraudulent billing scheme targeting Medicare. Federal prosecutors say the fraud centered on durable medical equipment, specifically orthotic braces, billed without legitimate medical need.
Reinaldo Wilson, 57, formerly of Richmond Hill, Georgia, owned and operated two telemedicine companies based in Bayonne, New Jersey, between 2017 and 2019. Court filings and statements made at sentencing outline how those companies were used as the hub for the operation during that period.
Prosecutors say Wilson and co-conspirators paid illegal kickbacks to medical providers to have them sign orders for orthotic braces for Medicare beneficiaries who did not need them. Those signed orders were sold to marketing outfits that frequently resold the paperwork to brace suppliers, and the suppliers then submitted claims to Medicare for unnecessary equipment.
Investigators found providers working with Wilson signed orders for four or more orthotics for over 3,000 beneficiaries, and more than 40 beneficiaries were issued orders for 10 or more orthotics. During the conspiracy, Wilson and others submitted over $56 million in false and fraudulent claims to Medicare, of which Medicare paid out over $27.9 million.
“Instead of connecting patients with legitimate care, Reinaldo Wilson used his telemedicine companies to exploit Medicare and line his own pockets,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “He stole over $27.9 million by submitting false and fraudulent claims, robbing a program designed to provide medical care to America’s seniors. The Criminal Division will aggressively prosecute those who defraud Medicare and exploit taxpayer-funded programs meant to serve the people who have paid into the system.”
Special Agent Stefanie Roddy of the FBI’s Newark Field Office spelled out the scale of the scheme and the threat such fraud poses to federal programs. “Over the span of only two years, Wilson amassed over $56 million in fraudulent Medicare claims, through a cadre of crooked medical providers and co-conspirators, leveraging durable medical equipment for personal financial gain,” said Special Agent in Charge Stefanie Roddy of the FBI’s Newark Field Office. “When criminals defraud Medicare, they undermine the U.S government. The FBI will always work to apprehend theses fraudsters and put an end to their schemes.”
Wilson also tried to hide his role by setting up another telemedicine company under someone else’s name and presenting it as an investment. Prosecutors say he persuaded a member of his church to accept a $20,000 investment, had that person register the company and open bank accounts in her name, and then moved to control those accounts himself.
“Today’s sentence underscores the serious consequences for those who exploit Medicare for personal gain,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS‑OIG). “This sentence reflects our commitment to holding individuals accountable when they manipulate providers, target vulnerable patients, and attempt to conceal fraud behind complex schemes. We will continue working with our law enforcement partners to ensure anyone who abuses federal health care programs is exposed and brought to justice.”
Wilson pleaded guilty in March 2021 to conspiracy to commit wire fraud and health care fraud. The case was investigated by the FBI, IRS Criminal Investigations, and HHS‑OIG, and prosecuted by Trial Attorneys Darren C. Halverson and Nicholas K. Peone of the Criminal Division’s Fraud Section.
The Criminal Division’s Fraud Section coordinates efforts to combat health care fraud through the Health Care Fraud Strike Force Program, which has operated since March 2007. That program, now made up of multiple strike forces across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.
