BOSTON—The owner of Conclave Media (Conclave) and Nationwide Health Advocates (Nationwide) pleaded guilty in connection with a $44 million telemedicine fraud scheme involving medically unnecessary durable medical equipment (DME), including orthotics such as back and knee braces and genetic tests.
David Santana, 38, of Reading, Mass. pleaded guilty to one count of conspiracy to commit health care fraud. U.S. District Court Judge Angel Kelley scheduled sentencing for Feb. 7, 2024. Santana was charged in July 2023.
Between January 2018 and August 2021, Santana, through his companies Conclave and Nationwide, entered into business relationships with telemarketing companies that generated leads by targeting Medicare beneficiaries. The telemarketers then paid Conclave and Nationwide on a per-order basis to generate orders for DME and genetic testing for these beneficiaries. To arrange for these orders to be signed, 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 falsely portrayed the medical providers as having performed a legitimate examination of the beneficiary. Santana then provided the signed orders to the telemarketing companies which sold the orders to DME suppliers and laboratories. Santana knew these DME suppliers and laboratories would use the signed orders to submit claims to Medicare for DME and genetic testing that were medically unnecessary, based on false documentation and tainted by kickbacks.
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. Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and statutes which govern the determination of a sentence in a criminal case.