Five Tampa Bay area residents are wrapped up in what federal prosecutors are calling a billion-dollar telemedicine rip off.
Starting in 2015, the defendants and their pharmacy companies set up an elaborate scheme that fraudulently solicited insurance coverage information and prescriptions from tens of thousands of consumers across the country, according to a 40-page indictment. They then used the information to sell pain creams and other similar products.
Doctors approved the prescriptions not knowing that the defendants and their companies had "massively marked up the prices" of the invalidly prescribed drugs, federal prosecutors said. For instance, several of the pharmacies paid $27 for a lidocaine numbing ointment and billed up to $381, an increase of more than 1,300 percent.
To ensure the most profit, some of the defendants "directed their employees to ‘test bill’ or ‘phish’ for the highest reimbursement items," the indictment stated. "These employees routinely submitted claims ... for this purpose, contrary to one of more provider agreements."
The scheme bilked $174 million from private health care companies, including Blue Cross Blue Shield, federal prosecutors said. In addition, the five men and their companies submitted at least $931 million in fraudulent claims.
Andrew Assad, 33, of Palm Harbor; Peter Bolos, 41 of Lutz; and Michael Palso, 44, of Odessa were indicted along with their compounding pharmacies: Synergy Pharmacy Services in Palm Harbor, and Precision Pharmacy Management in Clearwater.
Larry Everett Smith, 48, of Pinellas Park was also indicted. He ran Tampa Bay-based Tanith Enterprises, ULD Wholesale Group, Alpha-Omega Pharmacy, and Germaine Pharmacy along with Zoetic Pharmacy in Houston,, Texas.
The defendants and their companies face a total of 32 counts. All four men were charged with mail fraud, conspiracy to commit health care fraud and introducing misbranded drugs into interstate commerce. If convicted, they face up to 20 years in prison for each mail fraud charge, up to 10 years for each conspiracy charge and up to three years for the third charge. They and their companies could also be required to forfeit up to $154 million.
Last week, all four were released on bond after appearing in a federal courtroom in Tampa’s Middle District of Florida. The indictment was filed in the Eastern District of Tennessee.
Seminole resident Scott Roix, 52, the CEO of HealthRight, has already pleaded guilty to felony conspiracy for his role in the case, according to a statement from the U.S. Attorney’s Office in Tennessee.
Roix also pleaded guilty to conspiring to commit wire fraud in a separate case. He used 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 news release said.
While Roix faces up to 5 years in prison for each conspiracy charge, helping federal prosecutors with the case against the other men could help reduce his sentence.
Roix’s lawyer, Christopher Kise, said his client spent his life building a successful marketing business.
"HealthRight’s role here was primarily focused on the marketing aspects," said Kise, who served as solicitor general for Florida under former Gov. Charlie Crist. "While Mr. Roix certainly did not from the outset seek to engage in any unlawful conduct, once he became aware of the full nature and scope of the enterprise, he wisely chose to do the right thing for himself and his family and to accept responsibility."
Contact Graham Brink at firstname.lastname@example.org. Follow @GrahamBrink.