Telemarketing Firm Makes Huge Settlement To Resolve Health Care Fraud Claims

In last week’s blog, we shed light on the fact that
 health care fraud comes in all different forms. Reporting one case of food
 stamp fraud and another case dealing with the illegal import of syringes, we
 made clear that there really are no bounds to how people can fraudulently earn
 a buck. That includes calling people up on the phone to obtain information from
 them in order to pull off a scam.

For the most part, telemarketers already get a bad rap for both bothering people at home and attempting to sell products and services that aren’t worth what they cost. But, earlier this month, Scott Roix didn’t help the reputation of telemarketers any further. As reported by the Middle District of Florida branch of the United States Department of Justice, Roix and his telemarketing business have agreed to pay $2.5 million to resolve health care fraud claims.

The companies are alleged to have violated the False
 Claims Act by causing the submission of false claims to federal healthcare
 programs in connection with telemedicine health care fraud schemes. Roix’s
 health care fraud scheme was conducted in three ill-intentioned steps.

As explained by the DoJ, “(1) Roix and his marketing
 companies fraudulently obtained insurance coverage information from consumers
 across the country to arrange for them to receive prescription pain creams and
 other similar products, (2) these prescriptions were not medically necessary
 and did not arise from a valid doctor-patient relationship, and (3) Roix and
 his marketing companies sold these prescriptions to pharmacies under the guise
 of marketing services, and the payments solicited were based on the volume and
 value of the prescriptions.”

Among them is the accusation that, in September
 2014, one of his marketing companies, Health Savings Solutions was directed to
 receive payments from Oldsmar Pharmacy. These payments were based on the value
 and volume of prescriptions solicited by Health Savings Solutions in violation
 of the Anti-Kickback Statute, and the False Claims Act.

In a separate allegation, Roix directed another of
 his companies, HealthRight, from June 2015 through October 2018, to receive
 payments from Synergy Pharmacy. These payments were based on the value and
 volume of prescriptions solicited by HealthRight on behalf of Synergy Pharmacy.

Derrick L. Jackson is a Special Agent in Charge at
 the U.S. Department of Health and Human Services, Office of Inspector General
 in Atlanta.“Telemarketing fraud is a major threat to the integrity of the
 Medicare program,” he is quoted as saying in the DoJ report, “Unscrupulous
 companies collect patient information then sell it to pharmacies and other
 medical providers in exchange for kickbacks.”

Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help your case. Our experts have been providing expert clinical services for nearly two decades and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.

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