Digital healthcare in general and telehealth in particular aren’t immune to healthcare fraud.
Today, the U.S Department of Justice through the U.S. District Court for the Eastern District of Tennessee indicted four individuals and seven companies on 32 counts of fraud for allegedly trying to bilk the government out of $1 billion in prescription payments from telehealth visits.
The government charges that from June 1, 2015, through April 1 the four individuals, with ownership of seven specialty pharmacies in Florida and Texas, submitted $931 million in fraudulent claims tied to telehealth benefits.
Details remain sketchy but the indictment against the pharmacy owners alleges the owners set up an elaborate telemedicine scheme with telehealth services provider HealthRight LLC to fraudulently solicit insurance coverage information and prescriptions from consumers 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.
On Sept. 26, HealthRight, a telemedicine company with locations in Pennsylvania and Florida, and company CEO Scott Roix of Seminole, Florida, pleaded guilty to felony conspiracy for their roles in the telemedicine healthcare fraud scheme. Roix and HealthRight, also pleaded guilty to conspiring to commit wire fraud in a separate scheme to fraudulently telemarket dietary supplements, skin creams and testosterone, says the U.S Department of Justice.
The indicted individuals and their pharmacies–Synergy Pharmacy Services in Palm Harbor Florida; Precision Pharmacy Management, Tanith Enterprises, ULD Wholesale Group, Alpha-Omega Pharmacy in Clearwater, Florida; Germaine Pharmacy in Tampa, Florida, and Zoetic Pharmacy in Houston, were all also named and were charged with conspiracy to commit healthcare fraud, mail fraud, and introducing misbranded drugs into interstate commerce.
If convicted, the individuals face a term of up to 20 years in prison for 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 government says.
The companies face fines of up to “twice the gross loss sustained as a result of the conspiracy,” the indictment says. The indictment also seeks forfeiture of approximately $154 million in claims payments.
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