In a recent development, David Santana, the owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide), has pleaded guilty to a $44 million Medicare fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces, and genetic tests.
According to the U.S. Department of Justice, between January 2018 and August 2021, Santana, through his companies Conclave and Nationwide, entered into business relationships with telemarketing companies that targeted Medicare beneficiaries. These telemarketing companies then paid Conclave and Nationwide on a per-order basis to generate orders for DME and genetic testing for these beneficiaries.
Santana worked with medical staffing companies to find doctors and nurses who were willing to review and sign prepopulated orders, typically without any contact with the beneficiaries. The records falsified that the medical providers performed legitimate examinations for the beneficiary. These signed orders were provided to the telemarketing companies, which sold them to DME suppliers and laboratories. Santana was well aware that these suppliers and laboratories would submit claims to Medicare for unnecessary DME and genetic testing, based on fraudulent documentation and tainted by kickbacks.
The sentencing for David Santana is scheduled for February 7th, 2024. Acting United States Attorney Joshua S. Levy indicated that the charge of conspiracy to commit health care fraud provides for a sentence of up to 10 years in prison, supervised release for up to three years, and a fine of up to $250,000 or twice the gross pecuniary gain or loss, whichever is greater.
