Florida Pharmacy Owners Sentenced in Tennessee Over Multimillion-Dollar Nationwide Telemedicine Pharmacy Fraud Scheme – InsuranceNewsNet

WASHINGTON, May 18 — The US Department of Justice issued the following press release:

A federal judge from Greenville, TNcondemned two Florida men for their role in a multi-million dollar healthcare fraud scheme.

Peter Bolos44 years old, from Tampawas convicted by a federal jury in December 2021 of conspiracy to commit health care fraud, 22 counts of mail fraud, and introducing a mislabeled drug into interstate commerce. U.S. District Judge J. Ronnie Greer sentenced Bolos to 14 years in prison and ordered him to pay more than $24.6 million in return and $2.5 million in decline. The court also convicted Bolos’ co-defendant, Michael Palso48 years old, from Tampato 33 months in prison and sentenced him to pay more than $24.6 million in restitution. Palso previously pleaded guilty to his role in the conspiracy, as did 14 other defendants in related cases. The other defendants are expected to be sentenced later this week.

According to court documents and evidence presented at trial, Bolos, Palso and their co-conspirators, Andrew Assad, Scott Roix, larry smith, Mihir Taneja, Arun Kapoor and Maikel Bolos, as well as various other companies owned or controlled by some of these individuals, misled Pharmacy Benefit Managers (PBMs), such as Express Scripts and CVS Caremark, regarding tens of thousands of prescriptions. PBMs processed and approved prescription drug claims on behalf of insurance companies. Bolos and his co-conspirators defrauded PBMs by authorizing millions of dollars in claims that private insurers such as Tennessee Blue Shield Blue Crossand public insurers such as Medicaid and TRICARE, paid to pharmacies controlled by the co-conspirators.

“The heavy sentences handed down by the court reflect the seriousness of the crimes committed by the defendants in this case,” the assistant deputy attorney general said. Arun G. Rao, head of the civil division’s consumer protection branch. “The department will continue to work with its law enforcement partners to prosecute those who take advantage of telemedicine to perpetrate fraudulent schemes.”

“The scale of the drug fraud scheme orchestrated by these defendants and their conspirators was astonishing, and the prison sentences handed down by the Court reflect the gravity of their crimes,” said WE Attorney Francis M. Hamilton III for the Eastern District of Tennessee. “The financial harm caused by healthcare fraud affects all Americans, and the United States Attorney’s Office for the Eastern District of Tennessee will continue to support the cooperation among its federal law enforcement partners that is necessary to bring criminal crooks like these defendants to justice. »

“This conviction is the result of a multi-agency investigation into a complex telemedicine pharmacy fraud scheme, requiring significant investigative resources,” the Special Agent in Charge said. Joseph E. Carrico of FBIfrom the Knoxville field office. “The FBItogether with its law enforcement partners, will remain vigilant to ensure that unscrupulous individuals who exploit our healthcare system are brought to justice.”

“Dispensing mislabeled prescription drugs in the WE market puts the health of patients at risk,” said the special agent in charge. Justin C. Fielder of FDA Office of Criminal Investigations (OCI) Miami Field Office. “We will continue to pursue and bring to justice those who put profits before public health.”

“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” , said the special agent in charge. John Condon Homeland Security Investigations (HSI) Tampa. “This significant sentence should serve as a warning to anyone who tries to deceive the government and rob taxpayers.”

“Providers who solicit recipients’ personal information and use it to defraud federal health care programs not only compromise the integrity of those programs, but they also misuse valuable taxpayer dollars for selfish purposes,” said the special agent in charge. Tamala E. Miles of Department of Health and Social Services, Office of the Inspector General (HHS-OIG). “HHS-OIG is proud to work alongside our law enforcement partners to investigate and hold accountable perpetrators of federal health care fraud.”

“The US Postal Service, Inspector General’s Officewill continue to vigorously investigate those who commit fraud against federal benefit programs and the US Postal Service“, said the special agent in charge Matthew Modafferi of US Postal Service, Inspector General’s Office Northeast Region Field Office. “The conviction in this case sends a clear message to pharmaceutical companies that such tactics will not be tolerated. US Postal Service, Inspector General’s Office would like to thank our law enforcement partners and justice department for their dedication and effort in this investigation.”

Court documents and evidence at trial established that Bolos, Assad and Palso owned and operated Synergy Pharmacy in Palm Harbor, Florida. Under their leadership, Synergy employed Scott Roixa Florida telemarketer operating as HealthRight, to generate prescriptions for Synergy and the other pharmacies involved in the program. The prescriptions were usually for medications such as pain creams, scar creams and vitamins. To obtain the prescriptions, Roix used HealthRight’s telemarketing platform as a telemedicine service, cold calling consumers and urging them to accept the drugs and provide their personal insurance information. HealthRight then paid doctors to authorize prescriptions through its telemedicine platform, even though the doctors never communicated directly with patients and relied solely on the telemarketer screening process as the basis for their authorizations. Because this flawed and fraudulent process rendered the prescriptions invalid, the drugs were mislabeled under the Food, Drug and Cosmetic Act. Synergy and the other pharmacies nevertheless distributed the drugs to consumers under the program, so that Bolos could submit fraudulent claims.

Court documents and evidence at trial established that during the conspiracy, which lasted from May 2015 by April 2018Bolos and Palso, as well as the co-accused Andrew Assad, paid Roix millions of dollars to purchase at least 60,000 invalid prescriptions generated by HealthRight. Bolos selected specific drugs for prescriptions that he could submit for cost-effective reimbursements at inflated prices. Moreover, Bolos, Palso and Assad used illegal means to hide his activity from PBMs so that they would not be detected.

Sentencing of the other defendants – all of whom pleaded guilty before trial – are expected to take place later this week. larry smith, Alpha-Omega Pharmacy, Germaine Pharmacy, Zoetic Pharmacy, Tanith Enterprises LLC, ULD Wholesale Group and Taneja will be sentenced on May 17. Kapoor, Sterling Knight Pharmaceuticals and Maikel Bolos will be sentenced on May 18. Assad, Roix and HealthRight LLC will be sentenced on May 19. All sentencing will take place before Judge Greer in the United States District Court for the Eastern District of Tennessee to Greeneville.

The trial verdict and plea agreements are the result of a multi-year investigation conducted by HHS-OIG (Nashville); FDA-OCI (Nashville); US Postal Service, Inspector General’s Office (Buffalo); FBI (Knoxville and Johnson City, TN); OPM-IGO (Atlanta); and HSI (Tampa). the U.S. Marshals Service also participated in the investigation and asset forfeiture.

Assistant WE Lawyer MacHeavener of US Attorney’s Office for the eastern district of Tennessee and lead prosecutor David Gunn of the Consumer Protection Department of the Civil Chamber in Washington continue the case. They were assisted by Barbra Pemberton, Bryan Brandenburg and April Denard of US Attorney’s Office.

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See the links displayed in the text here: https://www.justice.gov/opa/pr/florida-pharmacy-owners-sentenced-tennessee-multimillion-dollar-nationwide-telemedicine