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.
According to the report, Roix operated a number of marketing companies.
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.”
The settlement resolves a number of allegations levied against Roix.
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.”
Are you an attorney who is currently trying a health care fraud case?
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.