The Department of Justice issued a press release last Friday announcing that several defendants had been convicted in a multimillion-dollar nationwide telemedicine fraud scheme. Eight individuals and their related corporations have pleaded guilty to intentionally misleading pharmacy benefit managers (PBMs) like Express Scripts and CVS Caremark about tens of thousands of prescriptions. PBMs, the statement said, then unknowingly authorized millions of dollars in claims that insurance companies paid to pharmacies controlled by the convicted persons and their related companies.
The statement explained that the convicted persons used a telemarketing platform to cold call consumers and convince them to provide their personal insurance information and to accept medications such as pain creams, scar creams and vitamins. . The defendants would then pay doctors to fill the prescriptions, although they would have no contact with the patients. The drugs would then be given to consumers so that fraudulent insurance claims could be filed.
The press release claims that the specific drugs were chosen because they could be subject to cost-effective reimbursements at inflated prices, and that the defendants “used unlawful means to conceal this activity from PBMs so that it could remain not detected”. The defendants were each ordered to serve jail time and pay varying amounts of restitution, ranging from $25,000 to $25 million.
Assistant Deputy Attorney General Arun G. Rao, head of the Civil Division’s Consumer Protection Division, said “the significant sentences imposed by the court reflect the seriousness of this large-scale fraudulent scheme, in which Defendant’s consumers deceived consumers in order to facilitate the dispensing of drugs without proper medical supervision and overbilling insurers for illegal prescriptions.
“Bolos and his co-conspirators abdicated their responsibilities in the healthcare industry through an elaborate fraud scheme and manipulated the system without regard to patient needs or medical necessity to line their pockets. added Special Agent John Condon of Homeland Security Investigations Tampa. Explain.
The multi-year investigation found that the plot took place from May 2015 to April 2018, a period during which at least 60,000 invalid orders were filed. Special Agent in Charge Amy K. Parker of the OPM OIG said, “Today’s sentencing holds the conspirators accountable for their reprehensible scheme that misled patients and defrauded the federal government.”