New York - A New York physician was charged in an indictment unsealed Thursday in the Eastern District of New York for an alleged $10 million health care fraud scheme involving the submission of false and fraudulent claims to Medicare and Medicare Part D plans.
According to court documents, Elemer Raffai, 56, of Rome, between approximately July 2016 and June 2017, allegedly signed prescriptions and order forms via purported telemedicine services for durable medical equipment (DME) that were not medically necessary. Raffai caused these claims to be submitted based solely on a short telephone conversation for beneficiaries he did not physically examine and evaluate and that were induced, in part, by the payments of bribes and kickbacks to Raffai. The indictment further alleges that Raffai, with others, submitted or caused the submission of approximately $10 million in false and fraudulent claims to Medicare for DME, and Medicare paid more than $4 million on those claims.
Raffai is charged with health care fraud. He was arrested and is making his initial court appearance today in the U.S. District Court for the Northern District of New York. If convicted, Raffai faces a maximum total penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.
Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney Breon Peace for the Eastern District of New York; Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; and Special Agent in Charge Janeen DiGuiseppi of the FBI’s Albany Field Office made the announcement.
HHS-OIG and the FBI investigated the case.
Trial Attorneys Kelly M. Lyons and Andrew Estes of the Criminal Division’s Fraud Section prosecuted the case.
An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.