Score:   1
Docket Number:   ND-FL  3:18-cr-00060
Case Name:   USA v. BURTON et al
  Press Releases:
 

PENSACOLA, FLORIDA – Michael Scott Burton, 52, of Decatur, Georgia, was sentenced to 96 months in federal prison yesterday after he pleaded guilty to charges of conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and money laundering. The sentence was announced today by Lawrence Keefe, United States Attorney for the Northern District of Florida.

Between January 2014 and December 2015, Burton conspired with others to defraud TRICARE and other insurance companies out of more than $6.5 million in fraudulent claims for prescriptions for compounded pain cream, scar cream, and wellness capsules. Burton agreed that co-defendant Brad T. Hodgson would forge prescriptions for compounded drugs for individuals who Burton knew were not patients of the Georgia doctor’s practice where Hodgson worked. Burton recruited sales representatives, including co-defendants Bradley D. Pounds and Heather E. Pounds, to obtain and provide Burton with the personal identifying information and insurance cards of individuals for whom the prescriptions could be issued in exchange for commission payments. Burton would forward that information to Hodgson, who would issue the prescriptions – even though he was not licensed to write prescriptions – and send them to Physician Specialty Pharmacy in Pensacola without the individuals ever seeing or speaking with a doctor. Burton also recruited co-defendant Marie Ann Smith to assist Hodgson with processing and submitting prescriptions. Physician Specialty Pharmacy then caused TRICARE and other insurance companies to be billed and paid Burton a 50% commission for each compounded drug prescription that was paid by insurance. By this conduct, Burton earned over $1.4 million in commissions from fraudulent prescriptions.

"Health care fraud is a crime that affects all Americans – but to perpetrate a scam that victimizes a program for our nation’s service members and their families is beyond appalling," Keefe said. "This conspiracy stole money meant to help those who have given so much to our nation, and the criminals behind it deserve the punishment they receive."

"The wide-spread corruption uncovered in this complex and multistate fraud scheme wasted millions of American taxpayer dollars, and furthermore, deprived U.S. military members and their families of legitimate prescription medications and other needed medical care," said Cynthia A. Bruce, Special Agent in Charge, DCIS-Southeast Field Office. "DCIS is committed to working with our investigative partners and the U.S. Attorney's Office to identify, investigate and bringing to justice anyone who defrauds the DoD and the American taxpayer."

For his role in the scheme, Burton was sentenced to 96 months in prison. He was also ordered to pay $$6,540,348.48 in restitution to TRICARE and pay a forfeiture money judgment of $1,480,931.74. In February, Bradley Pounds was sentenced to 21 months in prison, and Smith and Heather Pounds were sentenced to probation. In separate related cases, Hodgson is awaiting sentencing after pleading guilty, and Andrew E. Fisher, the president and part-owner of Physician Specialty Pharmacy, is awaiting trial scheduled for September 3rd.

"Crimes like this increase the costs we all pay for healthcare and prescription drugs," said FDLE Commissioner Rick Swearingen. "I thank our FDLE Pensacola office for spearheading this complex investigation and our U.S. Attorney’s Office for prosecuting this case."

Assistant United States Attorney Alicia H. Forbes prosecuted these cases following an investigation by the Federal Bureau of Investigation, Defense Criminal Investigative Service, Florida Department of Law Enforcement, Florida Department of Financial Services-Bureau of Insurance Fraud, Florida Department of Health, Naval Criminal Investigative Service, and Army Criminal Investigative Command.

The United States Attorney’s Office for the Northern District of Florida is one of 94 offices that serve as the nation’s principal litigators under the direction of the Attorney General. To access public court documents online, please visit the U.S. District Court for the Northern District of Florida website. For more information about the U.S. Attorney’s Office, Northern District of Florida, visit https://www.justice.gov/usao-ndfl

PENSACOLA, FLORIDA – Michael Scott Burton, 51, of Decatur, Georgia; Marie Ann Smith, 54, of Auburn, Georgia; Bradley D. Pounds, 46, of Jacksonville, Florida; and Heather E. Pounds, 45, also of Jacksonville, were arraigned on Tuesday, June 26, after a federal grand jury returned an indictment charging them with conspiracy to commit health care fraud and wire fraud.  Additionally, Burton was charged with conspiracy to commit money laundering and 10 counts of money laundering.  The indictment was announced by Christopher P. Canova, United States Attorney for the Northern District of Florida.

The indictment alleges the following:

TRICARE and other private insurance companies were defrauded of more than $8 million for compounded creams and pills that were not medically necessary.  The individuals who were provided the compounded creams and pills never saw the “prescribing” health care provider.

As a part of this scheme, Burton contacted Brad Hodgson, an employee with a doctor’s office in Atlanta, Georgia, and asked Hodgson to write compounded cream prescriptions for individuals who were not patients of the doctor’s practice where Hodgson worked.  Upon Hodgson’s agreement to write the prescriptions, and as part of the scheme, Burton arranged for the Pounds and others to become “representatives” for Burton’s company, Simply Surgical.  These representatives provided Burton with the personal identifying information and insurance cards of insurance company beneficiaries for whom the prescriptions could be issued.  Burton agreed to pay the representatives for the information they provided him.

Following Burton’s receipt of the personal identifying information, Burton e-mailed the information to Hodgson and Smith, a billing coordinator at the Atlanta doctor’s office.  Hodgson and Smith then caused prescriptions, purportedly signed by the Atlanta doctor and bearing the doctor’s DEA registration number, to be issued and faxed to a pharmacy in Pensacola.  The doctor did not authorize or sign the prescriptions Hodgson and Smith submitted.  Further, the health care beneficiaries whose information was submitted by Burton were not patients of the doctor’s office.  The prescriptions issued were not medically necessary and were not provided by an authorized health care provider.

Following receipt of the prescriptions, employees of a Pensacola pharmacy manufactured compounded substances and then caused the substances to be shipped to the respective health care beneficiaries.  The Pensacola pharmacy caused TRICARE and other health care benefit programs to be billed for the prescriptions.

By this conduct, Burton and others defrauded TRICARE and other health care benefit programs of more than $8 million.  The trial is scheduled for August 6, 2018.

If convicted, all defendants face a maximum of 10 years in prison for each count of health care fraud conspiracy and a maximum of 20 years in prison for each count of wire fraud conspiracy.  If convicted, Burton faces a maximum of 10 years in prison for each count of money laundering and money laundering conspiracy.

The case is being investigated by the Defense Criminal Investigative Service; the Florida Department of Law Enforcement; the Florida Department of Financial Services, Bureau of Insurance Fraud; and the Federal Bureau of Investigation.  The case is being prosecuted by Assistant United States Attorney Tiffany H. Eggers.

An indictment is merely an allegation by a grand jury that a defendant has committed a violation of federal criminal law and is not evidence of guilt.  All defendants are presumed innocent and entitled to a fair trial, during which it will be the government’s burden to prove guilt beyond a reasonable doubt in a court of law.

About the National Health Care Fraud Takedown:

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III announced today the largest ever health care fraud enforcement action involving 601 charged defendants across 58 federal districts, including 165 doctors, nurses, and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.  Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.  Thirty state Medicaid Fraud Control Units also participated in today’s arrests.  In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.

Attorney General Sessions and Secretary Azar were joined in the announcement by Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Deputy Director David L. Bowdich of the FBI, Assistant Administrator John Martin of the Drug Enforcement Administration (DEA), Deputy Inspector General Gary Cantrell of the HHS Office of Inspector General (OIG), Deputy Chief Eric Hylton of IRS Criminal Investigation (CI), Centers for Medicare and Medicaid Services (CMS) Deputy Administrator and Director of the Center for Program Integrity Alec Alexander, and Director Dermot F. O’Reilly of the Defense Criminal Investigative Service (DCIS).

Today’s enforcement actions were led and coordinated by the Criminal Division, Fraud Section’s Health Care Fraud Unit in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership between the Criminal Division, U.S. Attorney’s Offices, the FBI and HHS-OIG.  In addition, the operation includes the participation of the DEA, DCIS, IRS-CI, Department of Labor, other various federal law enforcement agencies, and State Medicaid Fraud Control Units.

The charges announced today aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries.  The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department.  According to the CDC, approximately 115 Americans die every day of an opioid-related overdose.

“Health care fraud is a betrayal of vulnerable patients, and often it is theft from the taxpayer,” said Attorney General Sessions.  “In many cases, doctors, nurses, and pharmacists take advantage of people suffering from drug addiction in order to line their pockets.  These are despicable crimes.  That’s why this Department of Justice has taken historic new steps to go after fraudsters, including hiring more prosecutors and leveraging the power of data analytics.  Today the Department of Justice is announcing the largest health care fraud enforcement action in American history.  This is the most fraud, the most defendants, and the most doctors ever charged in a single operation—and we have evidence that our ongoing work has stopped or prevented billions of dollars’ worth of fraud.  I want to thank our fabulous partners with the FBI, DEA, our Health Care Fraud task forces, HHS, the Defense Criminal Investigative Service, IRS Criminal Investigation, Medicare, and especially the more than 1,000 federal, state, local, and tribal law enforcement officers from across America who made this possible.  By every measure we are more effective at finding and prosecuting medical fraud than ever.”

“Every dollar recovered in this year’s operation represents not just a taxpayer’s hard-earned money—it’s a dollar that can go toward providing healthcare for Americans in need,” said HHS Secretary Azar.  “This year’s Takedown Day is a significant accomplishment for the American people, and every public servant involved should be proud of their work.”

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare, Medicaid, TRICARE, and private insurance companies for treatments that were medically unnecessary and often never provided.  In many cases, patient recruiters, beneficiaries and other co-conspirators were allegedly paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare.  Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of submitting a total of over $2 billion in fraudulent billings.  The number of medical professionals charged is particularly significant, because virtually every health care fraud scheme requires a corrupt medical professional to be involved in order for Medicare or Medicaid to pay the fraudulent claims.  Aggressively pursuing corrupt medical professionals not only has a deterrent effect on other medical professionals, but also ensures that their licenses can no longer be used to bilk the system.

“Healthcare fraud touches every corner of the United States and not only costs taxpayers money, but also can have deadly consequences,” said FBI Deputy Director Bowdich.  “Through investigations across the country, we have seen medical professionals putting greed above their patients’ well-being and trusted doctors fanning the flames of the opioid crisis.  I want to thank the agents, analysts and our law enforcement partners in every field office who work each and every day to stop these criminals and hold them accountable for their actions.”

“DEA is committed to ending the opioid crisis occurring in our communities and preventing prescription drug misuse,” said DEA Assistant Administrator Martin.  “DEA will continue to work with our partners every day to protect our citizens while ensuring that patients have adequate access to these critical medications.”

“This year’s operations, focusing on opioid-related schemes, spotlight the far-reaching impact of health care fraud,” said HHS Deputy Inspector General Cantrell.  “Such crimes threaten the vitally important Medicare and Medicaid programs and the beneficiaries they serve.  Though we have made significant progress in our fight against health care fraud; our efforts are not complete.  We will continue to work with our partners to protect the health and safety of millions of Americans.”

“It takes a special kind of person to prey on the sick and vulnerable as happened in many of these health care fraud schemes,” said Deputy Chief Hylton.  “Medical professionals and others callously placed individuals and vital healthcare services in harm’s way simply because of greed.  IRS-CI special agents continue to work side-by-side with other federal, state, and local law enforcement officers to uncover these schemes and hold these criminals accountable for their actions.”

“CMS makes it a top priority to protect the health and safety of millions of beneficiaries who depend on vital federal healthcare programs,” said Alec Alexander, deputy administrator and director of the Center for Program Integrity.  “CMS’ Center for Program Integrity collaborates closely with our law enforcement partners to safeguard precious taxpayer dollars.  Under Administrator Seema Verma, we will continue to strengthen this partnership with law enforcement in order to ensure the integrity and sustainability of these essential programs that serve millions of Americans.”

“Heath care fraud wounds our service members and veterans alike, as they rely upon and rightfully expect uncompromised care through the Department of Defense’s TRICARE Program,” said DCIS Director O’Reilly.  “Investigations that culminated in enforcement actions over the past several days underscore the steadfast commitment of the Defense Criminal Investigative Service and our investigative partners to vigorously investigate fraud impacting TRICARE.  We remain vigilant in our efforts to ensure the high standards of care our service members, military retirees, and their dependents deserve while safeguarding American taxpayer dollars.”

The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  The Medicare Fraud Strike Force operates in 10 locations nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,700 defendants who collectively have falsely billed the Medicare program for over $14 billion.

The United States Attorney's Office for the Northern District of Florida is one of 94 offices that serve as the nation’s principal litigators under the direction of the Attorney General.  To access public court documents online, please visit the U.S. District Court for the Northern District of Florida website.  For more information about the United States Attorney’s Office, Northern District of Florida, visit http://www.justice.gov/usao/fln/index.html.

Description: The fiscal year of the data file obtained from the AOUSC
Format: YYYY

Description: The code of the federal judicial circuit where the case was located
Format: A2

Description: The code of the federal judicial district where the case was located
Format: A2

Description: The code of the district office where the case was located
Format: A2

Description: Docket number assigned by the district to the case
Format: A7

Description: A unique number assigned to each defendant in a case which cannot be modified by the court
Format: A3

Description: A unique number assigned to each defendant in a case which can be modified by the court
Format: A3

Description: A sequential number indicating whether a case is an original proceeding or a reopen
Format: N5

Description: Case type associated with the current defendant record
Format: A2

Description: A concatenation of district, office, docket number, case type, defendant number, and reopen sequence number
Format: A18

Description: A concatenation of district, office, docket number, case type, and reopen sequence number
Format: A15

Description: The status of the defendant as assigned by the AOUSC
Format: A2

Description: A code indicating the fugitive status of a defendant
Format: A1

Description: The date upon which a defendant became a fugitive
Format: YYYYMMDD

Description: The date upon which a fugitive defendant was taken into custody
Format: YYYYMMDD

Description: The date when a case was first docketed in the district court
Format: YYYYMMDD

Description: The date upon which proceedings in a case commenced on charges pending in the district court where the defendant appeared, or the date of the defendant’s felony-waiver of indictment
Format: YYYYMMDD

Description: A code used to identify the nature of the proceeding
Format: N2

Description: The date when a defendant first appeared before a judicial officer in the district court where a charge was pending
Format: YYYYMMDD

Description: A code indicating the event by which a defendant appeared before a judicial officer in the district court where a charge was pending
Format: A2

Description: A code indicating the type of legal counsel assigned to a defendant
Format: N2

Description: The title and section of the U.S. Code applicable to the offense committed which carried the highest severity
Format: A20

Description: A code indicating the level of offense associated with FTITLE1
Format: N2

Description: The four digit AO offense code associated with FTITLE1
Format: A4

Description: The four digit D2 offense code associated with FTITLE1
Format: A4

Description: A code indicating the severity associated with FTITLE1
Format: A3

Description: The title and section of the U.S. Code applicable to the offense committed which carried the second highest severity
Format: A20

Description: A code indicating the level of offense associated with FTITLE2
Format: N2

Description: The four digit AO offense code associated with FTITLE2
Format: A4

Description: The four digit D2 offense code associated with FTITLE2
Format: A4

Description: A code indicating the severity associated with FTITLE2
Format: A3

Description: The title and section of the U.S. Code applicable to the offense committed which carried the third highest severity
Format: A20

Description: A code indicating the level of offense associated with FTITLE3
Format: N2

Description: The four digit AO offense code associated with FTITLE3
Format: A4

Description: The four digit D2 offense code associated with FTITLE3
Format: A4

Description: A code indicating the severity associated with FTITLE3
Format: A3

Description: The FIPS code used to indicate the county or parish where an offense was committed
Format: A5

Description: The date of the last action taken on the record
Format: YYYYMMDD

Description: The date upon which judicial proceedings before the court concluded
Format: YYYYMMDD

Description: The date upon which the final sentence is recorded on the docket
Format: YYYYMMDD

Description: The date upon which the case was closed
Format: YYYYMMDD

Description: The total fine imposed at sentencing for all offenses of which the defendant was convicted and a fine was imposed
Format: N8

Description: A count of defendants filed including inter-district transfers
Format: N1

Description: A count of defendants filed excluding inter-district transfers
Format: N1

Description: A count of original proceedings commenced
Format: N1

Description: A count of defendants filed whose proceedings commenced by reopen, remand, appeal, or retrial
Format: N1

Description: A count of defendants terminated including interdistrict transfers
Format: N1

Description: A count of defendants terminated excluding interdistrict transfers
Format: N1

Description: A count of original proceedings terminated
Format: N1

Description: A count of defendants terminated whose proceedings commenced by reopen, remand, appeal, or retrial
Format: N1

Description: A count of defendants pending as of the last day of the period including long term fugitives
Format: N1

Description: A count of defendants pending as of the last day of the period excluding long term fugitives
Format: N1

Description: The source from which the data were loaded into the AOUSC’s NewSTATS database
Format: A10

Description: A sequential number indicating the iteration of the defendant record
Format: N2

Description: The date the record was loaded into the AOUSC’s NewSTATS database
Format: YYYYMMDD

Description: Statistical year ID label on data file obtained from the AOUSC which represents termination year
Format: YYYY

Data imported from FJC Integrated Database
F U C K I N G P E D O S R E E E E E E E E E E E E E E E E E E E E