Articles Tagged with #fraudkickbacks

IMG_0350-300x200Scott Roix, as well as HealthRight, LLC, Health Savings Solutions, LLC, Vici Marketing, LLC, and Vici Marketing Group, LLC, have agreed to pay $2.5 million to resolve allegations that they violated the False Claims Act through their telemedicine scheme.

According to the Department of Justice, Roix and the marketing companies fraudulently obtained insurance coverage information from patients with the purpose of prescribing them unnecessary pain cream products. The defendants then sold the prescriptions to numerous pharmacies, profiting from payments that were determined by the volume and value of the prescriptions. Roix and the marketing companies disguised the sale of these prescriptions by noting them as marketing services in their financial records.

As part of the telemedicine scheme, Roix and the marketing companies targeted consumers across the country, convincing them to divulge their insurance information to what they thought was a trusted entity. This scheme represents one of many attempts by scammers to utilize telemedicine for fraudulent activities. The elderly community is particularly prone to this method of fraud, and as a result has been impacted significantly.

IMG_0315-300x200A civil health care fraud lawsuit has been filed against Life Spine Inc., as well as its founder and president, Michael Butler, and Vice President of development, Richard Greiber, for allegedly paying millions of dollars in kickbacks to surgeons for using their spinal implants, equipment, and other devices. According to the lawsuit, the surgeons who received kickbacks from Life Spine Inc. accounted for half of the company’s total sales from 2012-2018.

Life Spine Inc. is headquartered out of Huntley, Illinois and specializes in the development and manufacturing of devices used in spinal surgeries. This includes spinal implants and instruments under the Life Spine Products line.

In 2012, Butler and Greiber began aggressively recruiting surgeons to act as paid consultants for the company. Butler and Greiber also promised surgeons that any patent applications that were transferred to Life Spine Inc. would result in the related products being brought to market. However, these agreements were contingent on the surgeons’ continued use of Life Spine Products. In exchange, the surgeons received up-front intellectual property acquisition fees for their patent transfers, as well as royalties for sales from the patented products, and regular consulting fees.

IMG_0265-300x200Daniel Ferguson, John Frohrip, and Kevin Partin, pleaded guilty to violating federal anti-kickback statutes following allegations that they paid illegal kickbacks and recruited doctors to write prescriptions for expensive drugs as part of their health care fraud scheme.

According to the Department of Justice, the defendants recruited physicians to write prescriptions for complex drugs that would qualify for lucrative reimbursements from insurance programs. After the drugs were prescribed to patients, the defendants would then apply for reimbursements through various federal health care insurance programs and use the profits for their personal expenses.

Each of the defendants admitted to offering to pay kickbacks to the physicians they were attempting to recruit in their scheme. On many occasions they were successful in their recruitment, including the payment of $15,000 to Dr. John Main of Tulsa for his participation in the scheme.

 

A U.S. District Court judge sentenced a former CEO of defrauding American Senior Communities among other entities. James Burkhart will spend 9½ in years in prison for fraud. Burkhart is one of four people accused of a massive fraud and kickback scheme that netted $19 million dollars. Burkhart pleaded guilty in December after a years long investigation by the FBI. During that investigation, agents discovered safe deposit boxes at his office and home with 350 gold coins and gold bars, and more than $1 million cash. The FBI was tipped by a vendor who was approached about their fraud and kickback scheme. Burkhart has been considered the ringleader of the conspiracy and the public interest in his case has been great. In fact, the courtroom was standing room only for his sentencing. American Senior Communities filed suit, accusing Burkhart, other former top executives and former vendors for “systematically looting” the long-term care provider from 2008 to 2015. Also named in the lawsuit were the company’s former COO Daniel Benson, former CFO Roger Werner, Burkhart’s business associate Steven Ganote, and Burkhart’s brother Joshua Burkhart.

Authorities said that over a six-year period, the accused used shell companies to falsify and inflate costs of goods and services, allowing them to steal discounts and rebates, and conceal kickbacks. They have all agreed to plea deals to settle the investigation. Burkhart must also pay full restitution. Burkhart was board chairman of the Indiana Health Care Association at the time of the FBI raids. At the time, American Senior Communities operated nearly 100 skilled nursing, hospice and assisted living facilities in Indiana and Kentucky. The 4, including Buckhart, spent millions on sporting events, private flights and gift cards alone. They were indicted on charges of defrauding American Senior Communities, the Medicare and Medicaid programs, the local county health department, a health foundation and others.