DME and Telemedicine Fraud: Why Physicians Are Now the Primary Federal Targets

If you signed telemedicine orders for durable medical equipment, genetic tests, or wound care products between 2020 and 2024, the federal government likely already has your name. The question is whether they have come for it yet.

In the 2025 healthcare fraud takedown, the DOJ explicitly turned its attention to providers.

On June 30, 2025, the Department of Justice announced the largest healthcare fraud takedown in American history. Three hundred and twenty-four defendants were charged across fifty federal districts. Intended loss: $14.6 billion. Of those defendants, ninety-six were doctors, nurse practitioners, pharmacists, and other licensed medical professionals. Forty-nine were charged specifically in telemedicine and genetic testing schemes worth $1.17 billion. The Southern District of Florida charged a single owner with a $46 million telemedicine and DME scheme as part of that same operation.

This is not winding down. It is the start of a multi-year wave.

What the 2025 Takedown Actually Means for Doctors

For most of the last decade, federal healthcare fraud prosecutions targeted the people running the schemes: the marketers, the call center operators, the DME company owners, the platform CEOs. The doctors signing the orders were treated as witnesses or unindicted co-conspirators.

That has changed. In the 2025 takedown, the DOJ explicitly turned its attention to providers. Ninety-six medical professionals were charged. Several drew sentences that would have been unthinkable five years ago:

• Jamie P. McNamara: 10 years federal prison, the statutory maximum, for a $174 million telemedicine fraud conspiracy involving labs in Louisiana and Texas.
• Dr. Jorge Zamora-Quezada, Texas rheumatologist: 10 years federal for a $325 million fraud scheme.
• Gary Cox, CEO of the DMERx software platform: convicted in the Southern District of Florida (1:23-cr-20271), sentenced December 2025 to 15 years for a $1 billion DME conspiracy.
• Operation Gold Rush: a transnational catheter scheme alleging $10.6 billion in fraudulent Medicare claims, with American physicians named in the order chain.

The pattern is consistent. Physicians who treated telemedicine signing as a side gig, who trusted the platform to handle compliance, who never spoke to the patients whose names appeared on the orders they signed, are now learning that those orders are the evidence.

Physicians who treated telemedicine signing as a side gig are now learning that the orders themselves are the evidence.

How These Investigations Actually Begin

Telemedicine and DME fraud cases rarely start with a complaint from a patient. They start with data. The Department of Justice now operates a Health Care Fraud Data Fusion Center that combines HHS-OIG, FBI, CMS, and DEA data with AI and cloud-based analytics. The system flags providers whose billing patterns deviate from their peers. A physician who signed several thousand braces orders in 2021, or who approved genetic tests for patients in states they were not licensed to practice in, will appear on a list.

From there, the standard investigative sequence is predictable:

• HHS-OIG opens a case file and pulls the National Provider Identifier billing history. Every claim associated with the physician is reconstructed.
• Subpoenas go to the telemedicine platforms, the DME companies, the labs, and the marketing firms. The contracts, the per-order fee structures, and the payment records are extracted.
• Cooperators are developed inside the marketing and platform companies, usually charged first and offered cooperation agreements in exchange for testimony against the providers.
• The provider receives a target letter, a grand jury subpoena, or a knock at the office. By the time that happens, the case file is largely complete.

Most physicians who get charged do not understand they were under investigation until the indictment is unsealed. By then, the cooperators have already given proffer statements, the documents are in the prosecutor's hands, and the charging decision has been made.

The Statutes That Drive Physician Exposure

Telemedicine and DME prosecutions are typically built on a stack of federal statutes. Each one carries serious exposure on its own. Together, they produce sentencing ranges that surprise physicians who assumed their license and clean record would carry weight.

• 18 U.S.C. § 1347 (healthcare fraud), up to 10 years per count, 20 if the fraud results in serious bodily injury, life if it results in death.
• 42 U.S.C. § 1320a-7b(b) (Anti-Kickback Statute), up to 10 years per count, with each kickback payment counting as a separate violation.
• 18 U.S.C. § 1349 (conspiracy to commit healthcare fraud or wire fraud), carrying the same maximum as the underlying offense.
• 18 U.S.C. § 1343 (wire fraud), up to 20 years per count.
• 18 U.S.C. § 1956 and § 1957 (money laundering), tacked on whenever kickback proceeds were deposited into bank accounts.
• 42 U.S.C. § 1320a-7 (mandatory exclusion from Medicare and Medicaid), which is a collateral consequence that ends most medical careers regardless of sentence length.

Sentencing in these cases is driven by the loss amount under USSG § 2B1.1. For a physician who signed orders that produced $5 million in Medicare billing, the base offense level alone puts them in a guideline range above five years before any aggravating enhancements are applied. Add abuse of position of trust under § 3B1.3 and sophisticated means under § 2B1.1(b)(10), both of which the government routinely seeks against licensed providers, and the range climbs further.

Restitution is mandatory under 18 U.S.C. § 3663A. Forfeiture under 18 U.S.C. § 982(a)(7) reaches every dollar traceable to the scheme, including assets that have nothing to do with the fraud directly. The financial exposure usually exceeds whatever the physician was paid for the signing work, often by orders of magnitude.

The standard investigative sequence runs HHS-OIG, then subpoenas, then cooperators, then the target letter. The case file is largely complete by the time the doctor knows.

The Defenses That Do Not Work

Doctors facing telemedicine and DME charges almost always reach for the same defenses. They almost always fail.

• "I trusted the platform." Federal courts have rejected this argument repeatedly. A licensed physician has an independent duty to verify medical necessity. Outsourcing that verification to a non-medical platform is not a defense; it is evidence of recklessness, which under the deliberate ignorance doctrine can satisfy the knowledge element of fraud.
• "I never spoke to the patients but I reviewed the records." If the records were generated by a telemarketer reading from a script, courts treat the review as a sham. Several recent convictions turned on chart notes that physicians admitted they spent less than 30 seconds reviewing.
• "I was paid per consultation, not per order." The Anti-Kickback Statute looks at the structure of the arrangement, not its label. If the per-consultation rate was set in a way that effectively rewarded volume of orders signed, the government will treat it as a kickback regardless of how the contract describes it.
• "I did not know the orders were fraudulent." Willful blindness instructions are routinely given in these cases. A physician who deliberately avoided learning where the patients came from, who paid for the consultations, or how the platform made money is not protected by the absence of actual knowledge.
• "I cooperated fully, so I should not be charged." Cooperation may help at sentencing if you are convicted. It does not prevent prosecution. Everything said to investigators without counsel can and will be used in the indictment. Federal agents are trained to take statements early, before targets understand they are targets.

What Actually Helps in Federal Healthcare Fraud Defense

Effective defense in DME and telemedicine cases looks nothing like a state criminal case and almost nothing like civil healthcare litigation. It is built on early intervention, parallel-track strategy, and meticulous attention to the way the federal system actually evaluates these prosecutions.

• Early counsel before any contact with agents. The first 48 hours after a target letter or subpoena arrives often determine whether a case ends in declination, deferred prosecution, or indictment. Physicians who try to handle the initial contact themselves, or who hire generalist criminal defense counsel without federal healthcare experience, lose ground that cannot be recovered later.
• Forensic reconstruction of the billing record. Before any negotiation with prosecutors, the defense needs an independent picture of what the physician actually signed, when, for whom, and at what compensation rate. Government billing summaries are often inaccurate or selectively framed.
• Parallel-track strategy. These cases generate criminal exposure, civil False Claims Act liability, HHS-OIG exclusion proceedings, state licensing board action, and DEA registrant action all at once. A defense that focuses only on the criminal track and ignores the rest produces avoidable losses on the others.
• Negotiation before indictment. The Health Care Fraud Strike Force has prosecutors who handle nothing else. They have charging discretion, and that discretion is widest before charges are filed. Declination submissions, reverse proffers, and pre-indictment resolutions are real options when the defense is positioned correctly and early.
• Sentencing and mitigation work that begins on day one. If a case is going to resolve in a plea or conviction, the sentencing record, restitution efforts, treatment, character development, and 3553(a) variance arguments all start being built at the first meeting with counsel. Federal judges can tell when mitigation was real and when it was assembled the week before sentencing.

Loss amount under USSG § 2B1.1 drives the sentencing math. Abuse of position of trust and sophisticated means add years.

Why Florida Physicians Are at Particular Risk

The Southern District of Florida has been the country's most active healthcare fraud prosecution district for over a decade, and that has not changed under the current administration. The 2025 takedown included high-dollar SDFL telemedicine and DME cases. The Florida Strike Force is fully staffed. Cases in Ocala, Gainesville, Tampa, Spring Hill, and Tarpon Springs were all unsealed as part of the same enforcement push.

Florida's geography and demographics have made it the national hub for Medicare fraud schemes for years. The same density of beneficiaries and operators that drove the original wave of pill mill, infusion clinic, and HHA prosecutions in the 2000s and 2010s now drives the telemedicine and DME wave. Federal prosecutors in Miami, West Palm Beach, and Fort Lauderdale handle these cases as their primary docket. They have seen every variation. They are not impressed by clean records or community letters as a substitute for substantive defense work.

If You Are a Physician Who Signed Telemedicine or DME Orders

There is a window. Most of the time, it is open before any contact from the government, when a physician realizes the volume of signing they did and starts to ask questions. Sometimes it is open after a subpoena arrives but before charges are filed. Occasionally it is still open after an indictment, but the leverage is much narrower.

The decisions that matter most in these cases are made early:

• Whether to retain federal-experienced counsel before any contact with agents.
• Whether to preserve communications, contracts, and payment records before they go missing.
• Whether to refuse a voluntary interview, take the Fifth in front of the grand jury, or proffer with a cooperation agreement.
• Whether to negotiate a pre-indictment resolution, fight at trial, or position for the lowest possible sentencing exposure if conviction is likely.

None of those decisions can be made well without complete information about the case, the prosecutor, the judge, the cooperators, and the guidelines exposure. They cannot be made on instinct. They cannot be made by a state criminal lawyer or a healthcare regulatory attorney working alone. Federal healthcare fraud defense is its own practice, and the physicians who navigate it well treat it that way from the first phone call.

Aaron M. Cohen handles federal healthcare fraud cases for physicians, telehealth providers, and DME owners across the Southern District of Florida and nationally.

Under Federal Investigation for DME, Telemedicine, or Healthcare Fraud?

AMC Defense Law represents physicians, telehealth providers, DME owners, and other licensed professionals in federal healthcare fraud matters across the Southern District of Florida and nationally. Aaron Cohen has 30+ years of federal criminal defense experience and handles every case personally. The firm's approach is built for early intervention, parallel-track strategy, and the technical detail that federal healthcare prosecutions require.

If you have received a target letter, a grand jury subpoena, an HHS-OIG CID, or a contact from federal agents, or if you have reason to believe you may be under investigation, contact the firm for a confidential consultation.

If you or your loved ones have been arrested or are under investigation, call Aaron M. Cohen, 24 hours a day, to get help.