United States Attorney Maria Chapa Lopez and U.S. Attorney J. Douglas Overbey for the Eastern District of Tennessee announce that Scott Roix, together with several entities through which he ran his telemarketing business, including HealthRight, LLC; Health Savings Solutions, LLC; Vici Marketing, LLC; and Vici Marketing Group, LLC (hereinafter collectively referred to as “marketing companies”), have agreed to pay $2.5 million to resolve allegations that Roix and these marketing companies violated the False Claims Act by causing the submission of false claims to federal healthcare programs in connection with telemedicine health care fraud schemes.
The government alleged that: (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 United States Attorney’s Office is committed to protecting TRICARE and other federal health care programs from improper practices that harm our nation’s healthcare programs,” said U.S. Attorney Chapa Lopez. “Those who generate prescriptions for profit and violate the Anti-Kickback Statute will be held accountable.”
“Prescriptions and other medical services resulting from kickbacks undermine the integrity of our health care system,” said U.S. Attorney Overbey. “Telemedicine is a valuable service for our citizens, but it must not be abused. We will take action against individuals who break the law to make a profit at the expense of our federal healthcare programs and ultimately at the expense of the American taxpayer.”
“Telemarketing fraud is a major threat to the integrity of the Medicare program,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Unscrupulous companies collect patient information then sell it to pharmacies and other medical providers in exchange for kickbacks.”
U.S. Postal Service Office of Inspector General Special Agent in Charge Kenneth Cleevely, Eastern Area Field Office, stated, “The U.S. Postal Service spends billions of dollars per year in workers compensation-related costs, most of which are legitimate. However, when medical providers or companies choose to flout the rules and profit illegally, special agents with the USPS OIG will work with our law enforcement partners to hold them responsible. To report fraud or other criminal activity involving the Postal Service, contact our special agents at www.uspsoig.gov or 888-USPS-OIG.”
“This settlement demonstrates the commitment of the Defense Criminal Investigative Service and our law enforcement partners to ensure that individuals do not unjustly enrich themselves by abusing the Department of Defense TRICARE program. DCIS protects the integrity of DoD programs by rooting out fraud, waste, and abuse which diverts American taxpayer dollars intended to support our Warfighters,” said Special Agent in Charge, Cyndy Bruce, Southeast Field Office.
“Today’s settlement demonstrates the commitment of the Office of Personnel Management Office of the Inspector General and our law enforcement partners at the Department of Justice to ensuring that federal health care programs, including the Federal Employees Health Benefits Program, are protected from fraud and abuse,” said Thomas W. South, the OPM Deputy Assistant Inspector General for Investigations. “I am immensely proud of the work our office has done to not only safeguard taxpayer dollars, but also protect the health and wellbeing of federal employees, annuitants, and their families.”
“This settlement emphasizes the collaborative effort by the FBI and our law enforcement partners to target those individuals who cheat the system and destroy public trust in our federally funded healthcare programs,” said Michael F. McPherson, Special Agent in Charge of the FBI Tampa Division.
The settlement resolves allegations that, beginning in September 2014, Health Savings Solutions, at the direction of Roix, received payments from Oldsmar Pharmacy that 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. These allegations were brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. The qui tam case against Roix and Health Savings Solutions was filed by Jennifer Silva and Jessica Robertson and is captioned: United States ex rel. Silva, et al. v. Vici Marketing, LLC, et al., Middle District of Florida (Case No. 8:15-cv-444-T-33TGW). Ms. Silva and Ms. Robertson will receive $287,500 of the settlement.
The settlement also resolves allegations that, from June 2015 through October 2018, HealthRight, at the direction of Roix, received payments from Synergy Pharmacy that were based on the value and volume of prescriptions solicited by HealthRight on behalf of Synergy Pharmacy. These allegations were also the subject of a criminal case captioned United States v. Scott Roix, et al., Eastern District of Tennessee (Case No. 2:18-cr-133), in which Roix and HealthRight pleaded guilty in September 2018.
This investigation was a collaborative effort between the U.S. Attorneys’ Office of the Eastern District of Tennessee and the Middle District of Florida. It was handled by Assistant U.S. Attorneys Jeremy Dykes, Michael Kenneth, and Jessica Sievert, with support from HHS-OIG, OPM-OIG, USPS-OIG, DOD-DCIS, and FBI.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
Tampa, FL – United States Attorney Roger B. Handberg announces today that the United States has obtained more than $370 million in judgments against a Kentucky businessman and his companies for a laboratory testing scheme that targeted the Medicare program.
In August 2022, the United States filed a complaint-in-intervention against Rajen Shah and his companies United Diagnostics Lab, Tomoka Medical Lab, Tennessee Valley Regional Laboratory, Luminus Diagnostics, and Golden Rule Management for violations of the False Claims Act. The complaint alleged that Shah caused his laboratories to bill Medicare for expensive molecular tests that were not ordered by a licensed healthcare provider.
On September 21, 2023, the district court granted the United States’ motion for default judgment and awarded judgment in favor of the United States and against the defendants in the amount of $105,634,097.50 for Shah, $6,159,118 for Tomoka Medical Lab, Inc., $23,996,305.50 for Tennessee Valley Regional Laboratories, LLC, $75,478,674.00 for Luminus Diagnostics, LLC, $105,634,097.50 for Golden Rule Management, LLC, and $54,587,325.00 for United Diagnostics Lab, LLC.
“The integrity of our healthcare system depends on the government being able to rely on accurate and truthful information submitted by laboratories, and that labs only bill for services ordered by a beneficiary’s doctor or nurse practitioner,” said U.S. Attorney Handberg. “We will continue to hold people accountable when they disregard Medicare’s regulations.”
“Providers who seek to boost their own profits by submitting inaccurate billing information to federal health care programs like Medicare undermine the integrity of these programs, which beneficiaries rely on for safe and effective health care services,” stated Acting Special Agent in Charge Julie Rivera of the U.S. Department of Health and Human Services Office of Inspector General. “Our agency, working with our law enforcement partners, will continue to investigate health care fraud schemes, including those involving providers allegedly submitting fraudulent claims in violation of the False Claims Act.”
In 2021, Shah received a jail sentence for a criminal contempt charge stemming from his violation of court orders related to the United States’ fraud investigation.
This case was investigated by the U.S. Attorney’s Office and the U.S. Department of Health and Human Services – Office of Inspector General. The case was handled by Assistant U.S. Attorney Sean Keefe.
The False Claims Act is a federal statute originally enacted in 1863 in response to defense contractor fraud during the American Civil War. It allows the United States to recover damages and penalties for the false or fraudulent submission of claims seeking reimbursement from the government. The United States intervened in a lawsuit originally brought by Jacqueline Cushing, a former Tomoka employee, under the whistleblower provisions of the False Claims Act. The Act permits private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery.
The case is captioned United States of America ex rel. Jacqueline Cushing v. Rajen Shah, et al, Case No. 19-cv-2997-T-33TGW.
United States Attorney Maria Chapa Lopez announces that the government has filed a civil lawsuit against Mihir Taneja alleging that Taneja conspired with Larry Smith, the owner of Z Stat Medical, LLC d/b/a Oldsmar Pharmacy, to enter into a kickback arrangement with a marketing company (Centurion Compounding, Inc.), which led to millions of dollars in TRICARE reimbursement for compounding prescriptions. Specifically, the lawsuit alleges that Taneja and Smith negotiated an arrangement with Centurion in which Centurion was paid a percentage of profits from TRICARE claims that Centurion referred to Oldsmar Pharmacy. As a result, from November 2014 to February 2015, Oldsmar Pharmacy submitted thousands of claims for reimbursement to TRICARE for compounded drugs that were tainted by kickbacks and, therefore, were false.
The actions of Taneja and his co-conspirators contributed to a larger fraud trend against TRICARE involving compounded prescriptions. TRICARE’s costs for compounded drugs skyrocketed during this period, rising from $5 million in 2004 to $514 million in 2014, before reaching a high water mark of $1.75 billion in fiscal year 2015. To date, the U.S. Attorney’s Office for the Middle District of Florida has diligently pursued fraud associated with compounding pharmacy claims, resulting in over $50 million in recoveries.
“Kickback arrangements skew the judgment of medical providers and threaten the integrity and viability of our healthcare programs,” said U.S. Attorney Chapa Lopez. “The TRICARE program has been particularly vulnerable to these schemes in recent years. We will use every remedy at our disposal, including the civil False Claims Act, to eradicate this kind of fraud from our district.”
The lawsuit is filed under the False Claims Act, which makes a person liable to the United States if he presents, or causes another to present, false or fraudulent claims for payments. The Anti-Kickback Statute prohibits anyone from offering or paying remuneration in order to induce or reward referrals for services paid for under federal healthcare systems.
The case is captioned United States v. Mihir Taneja, Case No. 8:21-cv-102-T-24AEP. The claims asserted by the government are allegations only, and there has been no determination of liability. The United States previously filed suit against Smith and Oldsmar Pharmacy arising out of the same conduct. That case is captioned U.S. ex rel. Silva, et al. v. Z Stat Medical, LLC, et al., No. 8:15-cv-00444-T-33TGW (M.D. Fla.).
The government’s complaint in this action illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800-HHS-TIPS (800-447-8477).
The case is being handled by Assistant U.S. Attorney Michael R. Kenneth of the U.S. Attorney’s Office for the Middle District of Florida, with assistance of the Department of Defense Office of Inspector General.
