The Allegiant Experts Blog has long covered a wide variety of health care fraud and medical misconduct stories from all over the country. But, being based in Windermere, Florida, our team can’t help but take notice of stories that emanate from the Sunshine State. This week, there are two, in particular, that deserve some attention – although it isn’t the type of attention we wish for Florida to have.
Fort Lauderdale lab owner charged in $53 million health care fraud scheme.
As reported by the District of New Jersey branch of the United States Department of Justice yesterday, 48 year-old Daniel Hurt has been charged. The Fort Lauderdale-based laboratory owner is accused of a $53.3 million health care fraud and kickback scheme related to genetic cancer screening tests. He has been charged with one count of conspiracy to commit health care fraud.
The DoJ reports that documents filed in Hurt’s case reveal that he owned numerous clinical laboratories. He is charged with paying kickbacks and bribes to various entities who supplied referrals and orders for genetic cancer screening tests (CGX). Hurt’s labs submitted claims for payment to Medicare and other health care benefit program beneficiaries for these CGX tests without regard to medical necessity.
“Medicare reimbursed the laboratories without knowing that the services were not medically necessary or were procured through the payment of kickbacks,” explains the DoJ report, “From January 2019 to October 2021, Hurt, through the laboratories, submitted or caused to be submitted approximately 350,000 claims to Medicare, including approximately 8,700 claims for beneficiaries residing in New Jersey.”
For each CGX referral supplied and billed to Medicare and other programs, Hurt paid a kickback. To conceal his bribe payments, he and his suppliers agreed to sham contracts. They made it appear as if the suppliers were engaged in, and being paid for, legitimate marketing and referral services. The scheme resulted in Medicare paying the labs at least $53.3 million for CGX test claims. Hurt received at least $26.9 million of that money. He now faces a maximum punishment of 10 years in prison and a maximum fine of $250,000.
Boca Raton chiropractor receives four-year prison term for health care fraud scheme.
The Middle District of Florida branch of the United States Department of Justice has reported that Jonathan Michael Rouffe has been sentenced to four years in prison. The 49 year-old Boca Raton chiropractor was convicted for his role in a $20 million health care fraud scheme. In addition to his sentence, Rouffe has been ordered to forfeit his assets from several bank accounts. They are all traceable to proceeds of the offense.
Court documents showed that, in 2018, Rouffe and his conspirators established a conglomerate of durable medical equipment (“DME”) supply companies. “During the creation of the companies, they lied to Medicare to secure billing privileges, including placing the companies in the names of straw owners,” details the DoJ, “By concealing their true ownership, the conspirators gained control of more companies, which Medicare generally prohibits, enabling them to submit high volumes of illegal DME claims.”
Through the conglomerate, Rouffe and his allies submitted over $20 million in illegal DME claims. The claims resulted in over $10 million in payments from Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (“CHAMPVA”). Rouffe’s team used illegal bribes and kickbacks to attain such high claims. On invoices, they disguised their illegal transactions as marketing services or “telemedicine”. In actuality, doctors were bribed in exchange for DME approvals.
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