Five Tampa Bay area residents are facing charges due to an alleged billion-dollar telemedicine scheme.
Starting in 2015, the men and their pharmacy companies are accused of setting up an elaborate scheme that fraudulently solicited insurance coverage information and prescriptions from tens of thousands of consumers across the country, according to a 40-page indictment. They then are accused of using the information to sell pain creams and other similar products.
Doctors apparently approved the prescriptions not knowing that the men and their companies had “massively marked up the prices” of the invalidly prescribed drugs, federal prosecutors said. For instance, several of the pharmacies paid $27 for a lidocaine numbing ointment and billed up to $381, an increase of more than 1,300 percent.
Police allege the men “directed their employees to ‘test bill’ or ‘phish’ for the highest reimbursement items” to ensure the most profit. According to the indictment, “These employees routinely submitted claims … for this purpose, contrary to one of more provider agreements.”
Federal prosecutors believe the alleged scheme bilked $174 million from private health care companies, including Blue Cross Blue Shield. In addition, the five men and their companies allegedly submitted at least $931 million in fraudulent claims.
The five men and their companies face a total of 32 counts. All four men were charged with mail fraud, conspiracy to commit health care fraud and introducing misbranded drugs into interstate commerce. If convicted, they face up to 20 years in prison for each mail fraud charge, up to 10 years for each conspiracy charge and up to three years for the third charge. They and their companies could also be required to forfeit up to $154 million.
Last week, four of the men were released on bond after appearing in a federal courtroom in Tampa’s Middle District of Florida. The indictment was filed in the Eastern District of Tennessee.
The fifth man charged has already pleaded guilty to felony conspiracy for his role in the case, according to a statement from the U.S. Attorney’s Office in Tennessee.
He also pleaded guilty to conspiring to commit wire fraud in a separate case.
While the man faces up to 5 years in prison for each conspiracy charge, helping federal prosecutors with the case against the other men could help reduce his sentence.
At Whittel & Melton, our Tampa Bay area Health Care Fraud Defense Attorneys handle criminal cases in Tampa and throughout the U.S. We represent health care practitioners, including doctors, nurse practitioners, therapists, clinics, hospitals, providers of medical equipment and billing companies facing criminal charges with the federal government, including:
- Overbilling for services
- Billing for services or tests not rendered
- Prescribing unnecessary or additional services in order to bill more
- Incorrectly reporting diagnoses, treatments or procedures to increase payments
- Unbundling billed services
- Using false billing codes
- Submitting duplicate claims
- Changing dates, services or names of patients on claims
- Altering medical records or reports
- Referral kickbacks or self-referrals
Health care fraud may be investigated by the FBI, the state Attorney General’s office, U.S. Postal Service or the Office of the Inspector General. Regardless of what department your case is being pursued by, we can apply the best possible defense strategy with the hopes of securing the best possible outcome.