Sixteen medical professionals, including six doctors and seven pharmacists, were among those charged in a Texas healthcare fraud and opioid takedown.
A coordinated healthcare fraud enforcement operation across the state of Texas resulted in charges against 58 people, according to the Department of Justice (DOJ). Twenty individuals were charged for their role in diverting opioids.
Charges were brought against individuals in all four federal districts in Texas for their alleged involvement in a number of Medicare fraud schemes and networks of so-called “pill mill” clinics that resulted in $66 million in losses and the distribution of 6.2 million pills, according to the DOJ.
The agency said the charges resulted from schemes billing Medicare, Medicaid, TRICARE, Department of Labor Office of Workers' Compensation Programs 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 allegedly involved in the unlawful distribution of opioids and other prescription narcotics.
The latest arrest comes three weeks after the filing of charges against dozens of people in a trafficking network responsible for diverting over 23 million oxycodone, hydrocodone and carisoprodol pills.
“As we continue to dedicate resources to battle healthcare and opioid fraud schemes in Texas and elsewhere, we are shining an inescapable light on dirty doctors, clinic owners, pharmacists and others who may have long believed they could perpetrate their frauds behind closed doors,” said Assistant Attorney General Brian Benczkowski of the DOJ's Criminal Division.
At a press conference, Benczkowski said two doctors were allegedly paid by the owners of three Dallas/Fort Worth-area pharmacies to refer unnecessary prescriptions for Office of Workers' Compensation claimants. The alleged scheme entailed over $158 million dollars in fraudulent claims for expensive compound creams and involved efforts to evade taxes resulting in approximately $23 million in tax losses. It resulted, thus far, in the freezing of over $60 million in assets traced to the alleged fraud.
The defendants also include two doctors who are charged with separately scheming to defraud TRICARE through compounding pharmacies in Fort Worth.
Also charged were owners and pharmacists from a “pill-mill” pharmacy in Houston. From March 2018 through September 2019, the pharmacy dispensed more than 760,000 pills of oxycodone, hydrocodone, carisoprodol and alprazolam. The pharmacy allegedly dispensed these substances on counterfeit prescription pads from doctors whose identities had been stolen, Benczkowski said. And it allegedly worked with “runners” who brought the illegitimate prescriptions to them to be filled for cash—all the while charging nearly five times the market value for equivalent oxycodone and hydrocodone prescriptions.
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In one case, three people were charged after the breach of a healthcare providers’ electronic health record (EHR) system. Demetrius Cervantes, 44, of McKinney, Texas; Amanda Lowry, 39, of Sherman, Texas, and Lydia Henslee, 27, of Denison, Texas, were indicted for conspiracy to obtain information from a protected computer and conspiracy to unlawfully possess and use a means of identification.
The three breached an EHR system to steal protected health information and personally identifiable information belonging to patients.
The information that was stolen was “repackaged” in the form of false and fraudulent physician orders and sold to durable medical equipment providers and contractors, the DOJ said. Within approximately eight months, the three obtained more than $1.4 million in proceeds from the sale of the stolen information. They used some of the money to buy new vehicles and jet skis, prosecutors said.