Telehealth vendor pleads guilty in $1B fraud scheme

HealthRight, a telemedicine vendor with locations in Pennsylvania and Florida, has pleaded guilty for its role in a $1 billion healthcare fraud scheme.

According to an announcement by the Department of Justice on Monday, HealthRight and Scott Roix—its CEO—pleaded guilty before U.S. District Judge J. Ronnie Greer of the Eastern District of Tennessee to felony conspiracy in the scheme, and also pleaded guilty to conspiring to commit wire fraud in a separate scheme for fraudulently telemarketing dietary supplements, skin creams and testosterone.

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Four other individuals and seven companies have been indicted in the scheme—all charged with conspiracy to commit healthcare fraud, mail fraud, and introducing misbranded drugs into interstate commerce.

The 32-count indictment, unsealed by the District Court for the Eastern District of Tennessee, alleges that these individuals and companies “conspired to deceive tens of thousands of patients and more than 100 doctors” nationwide “for the purpose of defrauding private healthcare benefit programs such as Blue Cross Blue Shield of Tennessee out of approximately $174 million” and submitted about $931 million in fraudulent claims for payment.

“According to the indictment, the defendants set up an elaborate telemedicine scheme in which HealthRight fraudulently solicited insurance coverage information and prescriptions from consumers across the country for prescription pain creams and other similar products,” notes the DOJ announcement. “The indictment states that doctors approved the prescriptions without knowing that the defendants were massively marking up the prices of the invalidly prescribed drugs, which the defendants then billed to private insurance carriers.”

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Roix faces a statutory maximum sentence of five years of imprisonment for each conspiracy, with sentencing set for Feb. 13, 2019.

“In addition to their roles in the healthcare fraud conspiracy, the information filed against Roix and HealthRight charged each of them with conspiring to commit wire fraud as part of a scheme to use HealthRight’s telemarketing facilities to fraudulently sell millions of dollars’ worth of products such as weight loss pills, skin creams and testosterone supplements through concocted claims of efficacy and intentionally deficient customer service designed to stall consumer complaints,” according to DOJ.

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