Four individuals involved in a conspiracy to plan and execute healthcare fraud have been indicted as federal authorities pouched on two of them. The four are believed to play a crucial part in various capacities representing some business entities and health facilities they worked for at the time. While indictment is not a formal charge in a court of law, the four defendants are severely implicated by the legal and investigating agencies of the misconduct. They will be charged formally in court after the investigations are complete.
Notably, the investigators point accusing figures on the Professional Compounding Pharmacy (PCP) as the primary company behind the scheme. James Bell owns the marketing firm based in the orange county providing pharmaceutical marketing services. Details showed how the plan organized by alleged ‘pain clinics’ run by PCP’s accomplished its mission by recruiting conspirators who would aid the illegal sale and administration of their products to innocent patients and obtain claims reimbursement from the healthcare programs. The accomplices targeted TRICARE and ILWU beneficiaries to their facilities.
The amount paid in bribes was established to be 200 dollars for every person who would seek treatment from the unscrupulous doctors working with PCP. They purported they had better pain cream but wanted to assess its effectiveness. Therefore, anyone who would accept to use it was ‘rewarded.’ The alleged drug trials attracted many patients covered under the targeted healthcare programs. Patients did not incur the cost, but their healthcare programs did. they also received bribes for participating in the ‘study.’ These compound creams were custom-made but established to be a fraudulent product aimed at defrauding healthcare programs
Further, it demonstrated the role of each individual accused in the deceptive plan. For example, James Bell was a principal mastermind as he owns PCP, including other drug marketing firms accused of being conduits of kickbacks to the company’s staff as well as patients. In essence, PCP was using its marketing team and established networks to quickly reach and trace beneficiaries of the healthcare plans above to be bribed. Wells ran the company operations and understood the dubious work done by his staff. Additionally, the company recruited other healthcare professionals to assist in prescribing the drugs, including unnecessary ones, but billed the healthcare plans a total of 22 million dollars. Of this amount, 19 million dollars was billed to TRICARE, and ILWU received bills totaling to 3 million dollars.
According to the evidence in the indictment, Wells also benefited from the proceeds of the fraudulent claims. While patients received 200 dollars, his marketing team was paid 50 percent of proceeds from bills of TRICARE and ILWU plans. His company was thus the biggest beneficiary of the loot. This illegal trade must have incentivized the marketers that he executed for a long time. As such, the company’s marketing team was motivated to find more doctors to prescribe the creams. Conversely, they recruited more patients to receive unjustified medical substances and defrauded their insurers of substantial amounts of money. He oversaw the kickbacks given to clients and medical practitioners for joining the conspiracy scheme.
Another defendant indicted is Regina Piehl, accused of overseeing the receipts and payments of kickbacks. She extensively worked with illegal medical professionals and the PCP team as the leading intermediary to make referrals and subsequent unlawful prescriptions. She benefited PCP through various firms she was involved with at the time. Dr. Michael Edwards did business deals with Piehl, including starting the alleged health facilities of studying the drug’s efficiency. He is the third defendant in this case for his role in prescriptions and illegally billing the healthcare programs to obtain untrue claims payments. The clinics were baits of prescribing the drugs that profited PCP together with its staff and proprietor. Evidence showed the medication was not necessary for patients. Additionally, the alleged studies were not genuine.
The fourth accused in the indictment is Sarah Samhat. She is alleged to work closely with Piehl and Dr. Edwards to make the prescriptions of the drugs to the patients recruited by the marketers. This prescription routing increased the sales of PCP and affiliated companies involved in the fraud scheme. She was, therefore, instrumental in making referrals to the clinics that would prescribe the creams and pay her kickbacks. Additionally, she facilitated the payment of bribes to the patients who readily accepted her referral suggestion to one of the clinics operated in this scheme. The four indicted persons have been close business partners for a long time, but they were running an illegal establishment.
To commit a compounding fraud, conspiracy to commit healthcare fraud, committing healthcare fraud and kickback allegations are crimes that can be punished by five years in prison for each count. Violation of the anti-kickback statute is punishable by a prison sentence of five years and a fine of 25,000 dollars or more depending on the liability established. Also, committing healthcare fraud can lead the defendant to a jail term of ten years, fines, restitution, and forfeiture of properties. One can still lose the authority to operate as a professional besides other punishments. Healthcare Fraud Group is an excellent team of defense lawyers that have been working with clients wrongly accused of healthcare fraud charges. If individuals are looking to maintain their innocence in court and are facing similar charges, they should take a step of contacting our criminal defense attorneys at 888-402-4054 to speak to a legal expert in healthcare fraud