https://www.justice.gov/opa/pr...ine-fraud-conspiracy

On October 12, 2018, the District Court for the Eastern District of Tennessee unsealed a 32-count indictment charging four individuals and seven companies in a $1 billion health care fraud scheme. The court also unsealed an additional two plea agreements and an information charging another individual and his company for their role in the scheme.

Andrew Assad, 33, of Palm Harbor, Florida, Peter Bolos, 41, of Lutz, Florida, and Michael Palso, 44, of Odessa, Florida, were indicted along with their compounding pharmacies, Synergy Pharmacy Services, located in Palm Harbor, and Precision Pharmacy Management, located in Clearwater. Co-conspirator Larry Everett Smith, 48, of Pinellas Park, Florida, also a pharmacy compounder, and his companies Tanith Enterprises, ULD Wholesale Group, Alpha-Omega Pharmacy, all located in Clearwater, Germaine Pharmacy located in Tampa, Florida, and Zoetic Pharmacy located in Houston, Texas, were all also named as defendants. All the defendants were charged with conspiracy to commit health care fraud, mail fraud, and introducing misbranded drugs into interstate commerce.

On September 26, 2018, HealthRight LLC, a telemedicine company with locations in Pennsylvania and Florida, and Scott Roix, 52, of Seminole, Florida, and the CEO of HealthRight, pleaded guilty to felony conspiracy for their roles in the telemedicine health care fraud scheme in a criminal information. Roix and HealthRight LLC, also pleaded guilty to conspiring to commit wire fraud in a separate scheme for fraudulently telemarketing dietary supplements, skin creams, and testosterone.

The indictment alleges that from June 1, 2015 through April 1, 2018, these individuals and companies, together with other persons and companies known to the grand jury, conspired to deceive tens of thousands of patients and more than 100 doctors located in the Eastern District of Tennessee and across the country for the purpose of defrauding private health care benefit programs such as Blue Cross Blue Shield of Tennessee out of approximately $174,000,000. The indictment further alleges that the defendants submitted not less than $931,000,000 in fraudulent claims for payment.

According to the indictment, the defendants set up an elaborate telemedicine scheme in which HealthRight fraudulently solicited insurance coverage information and prescriptions from consumers across the country for prescription pain creams and other similar products. The indictment states that doctors approved the prescriptions without knowing that the defendants were massively marking up the prices of the invalidly prescribed drugs, which the defendants then billed to private insurance carriers.

Assad, Bolos, Palso, and Smith appeared in court on October 11, 2018 before U.S. Magistrate Judge Anthony E. Porcelli in the U.S. District Court for the Middle District of Florida. All four individual defendants were released on bond and are scheduled for an initial appearance and arraignment in the U.S. District Court in the Eastern District of Tennessee before U.S. Magistrate Judge Clifton Corker on October 25, 2018.

If convicted, Assad, Bolos, Palso, and Smith face a term of up to 20 years in prison as to each mail fraud charge, up to 10 years in prison for the conspiracy, and up to three years in prison for introducing misbranded drugs into interstate commerce. Additionally, they face fines of up to $250,000 and up to three years of supervised release as to each count. The companies face fines of up to twice the gross loss sustained as a result of the conspiracy. The indictment also seeks forfeiture of approximately $154,000,000.

In addition to their roles in the health care fraud conspiracy, the Information filed against Roix and HealthRight charged each of them with conspiring to commit wire fraud as part of a scheme to use HealthRight’s telemarketing facilities to fraudulently sell millions of dollars’ worth of products such as weight loss pills, skin creams, and testosterone supplements through concocted claims of efficacy and intentionally deficient customer service designed to stall consumer complaints.

The investigation was conducted by the Nashville, Tennessee office of the U.S. Department of Health & Human Services Office of Inspector General; the Nashville office of the Food and Drug Administration Office of Criminal Investigations; the Buffalo, New York, office of the U.S. Postal Inspection Service; the Knoxville and Johnson City, Tennessee, offices of the Federal Bureau of Investigation; the Atlanta, Georgia, Office of Personnel Management Office of the Inspector General; and the Tampa, Florida, office of Homeland Security Investigations. The U.S. Marshals Service also assisted in the investigation and the forfeiture of assets.

Members of the public are reminded that an indictment constitutes only charges and that every person or company is presumed innocent until guilt has been proven beyond a reasonable doubt.

Fruit from the same tree . . .

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https://philadelphia.cbslocal....ate-health-benefits/

CAMDEN, N.J. (CBS) – An Ocean County woman is the latest of over 20 individuals the New Jersey U.S. Attorney’s Office has charged in allegedly defrauding New Jersey health benefits programs across the state.

Kristie Masucci, 36, of Cedar Run, admitted to defrauding New Jersey state health benefits programs and other insurers, according to U.S. Attorney Craig Carpenito.

She pleaded guilty in Camden federal court to information charging her with conspiracy to commit health care fraud.

Masucci defrauded New Jersey state health benefits programs and other insurers by submitting fraudulent claims for medically unnecessary prescriptions.

From January 2015 to February 2016, she recruited individuals in the state to get expensive and unnecessary “compounded medications” from an out-of-state pharmacy, referred to as the “Compounding Pharmacy.” Compound medication is medication that includes mixing ingredients to create a medicine special to the needs of an individual patient.

Masucci and her conspirators recruited public employees and individuals covered by the Pharmacy Benefits Administration and encourage them to fraudulently acquire the covered compounded medications from the Compounding Pharmacy without any request by a doctor saying the medication was necessary, according to officials.

The conspirators would have the prescriptions signed by a doctor who never evaluated if the patient medically needed the compounded medication. The prescriptions were then faxed to the Compounding Pharmacy.

After being filled, the pharmacy would pay one of Masucci’s conspirators a percentage of the prescription filled and paid for the Pharmacy Benefits Administrators. The money was then distributed to Masucci and conspirators.

The Pharmacy Benefits Administrator reportedly paid the Compounding Pharmacy for over $50 million for compounded medications mailed to individuals in New Jersey. Masucci and her partners were responsible for $1.88 million in prescriptions.

Masucci made $388,608 for her parts in the scheme.

She faces a maximum sentence of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense.

Sentencing is scheduled for Feb. 5, 2019. As part of her plea agreement, Masucci must forfeit the money she received during the scheme and pay restitution in an amount to be determined as sentencing.