An Ohio doctor has pleaded guilty after being accused of participating in a healthcare fraud conspiracy that resulted in over $14.5 million in bogus Medicare claims. Timothy Sutton, a 43-year-old North Ridgeville physician, was implicated in a scheme in which he issued needless medical orders and then billed them to Medicare, a federal health benefits program largely for the elderly. Sutton’s admission occurred as part of a bigger investigation involving two telemedicine companies and fraudulent actions in Ohio and Florida.
According to a news statement 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. Sutton was required to review and authorize pre-completed orders for durable medical equipment (DME) and cancer genomic testing (CGX) provided by these companies. According to documents, Sutton claimed to have examined patients using telemedicine to justify the need for these services; however, no such examinations occurred. This finding has now placed doubt on the legitimacy of telemedicine, particularly in the context of Medicare services.
The scheme did not end with the bogus 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, issued without sufficient medical justification, breached Medicare regulations and federal laws, effectively draining funds from the healthcare system.
Sutton’s plea last Friday included counts of attempted and conspiracy to commit wire and bank fraud, false statements regarding health care problems, and aggravated identity theft. The severity of these accusations could result in him serving up to 27 years in jail, with a sentencing hearing set for July 26. A federal district court judge will then decide the punishment 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 pursuing the case, Sutton’s guilty plea is a significant step forward in the ongoing fight against healthcare fraud.
