On October 27, 2020, a telemedicine executive was sentenced to 35 months’ imprisonment and ordered to pay over $2.5 million in restitution for his role in a scheme involving cancer genomic (CGx) testing.
James Simmons owned MedSymphony, a telehealth company that provided a portal to connect doctors and patients. In September 2019, he was indicted in the Southern District of Florida on several counts of healthcare fraud, conspiracy, and violations of the Anti-Kickback Statute. The indictment alleged that, through MedSympony, Simmons accepted bribes and kickbacks from marketing companies in exchange for completed doctors’ orders to support CGx testing. The kickbacks were disguised as contracts for telemedicine services.
To obtain the orders, Simmons bribed doctors—who contracted with MedSymphony to perform telemedicine consultations—to sign the orders. The doctors did not perform a legitimate telemedicine examination, and the tests were neither medically necessary nor eligible for Medicare reimbursement.
The completed orders were later sold to laboratories that used them to support false claims to Medicare for CGx testing. The reimbursement money paid to the laboratories would eventually flow back to the marketing companies, MedSymphony, Simmons, and the contracting physicians.
Simmons was one of several defendants charged related to the same scheme and one of many similar defendants charged in a wave of CGx-related and telemedicine-related cases. He previously pleaded guilty to one count of conspiracy to commit healthcare fraud under 18 USC § 1349 and had cooperated with prosecutors in a number of other cases.
The U.S. Sentencing Guidelines called for a sentence between 57 to 71 months. Simmons’s lawyers argued for a probation sentence, citing Simmons’ significant cooperation, the reduced sentences of persons in other CGx and telemedicine cases, and his lack of criminal history. The court did depart downward from the advisory sentencing range by about 40-percent, ultimately imposing 35 months’ imprisonment and over $2.5 million in restitution (owed jointly by Simmons and several other defendants in the same scheme). Interestingly, for reasons not stated in publicly available materials, the court permitted Simmons to wait until September 2021 before surrendering to begin his prison sentence.