John Oxendine, the former Georgia Insurance Commissioner, was sentenced to three and a half years in prison for conspiracy to commit healthcare fraud in connection with unnecessary lab testing.
“Oxendine abused his position as the former Georgia Insurance Commissioner by undermining the integrity of the state’s healthcare system when he conspired with a physician to order hundreds of unnecessary and costly lab tests,” said U.S. Attorney Ryan K. Buchanan. “This case demonstrates our office’s commitment to work with our law enforcement partners to hold individuals accountable who prioritize personal greed at the expense of the public’s trust.”
“John Oxendine was motivated more by personal greed than his duty to patients and the citizens of Georgia whom he used to represent,” said Keri Farley, Special Agent in Charge of FBI Atlanta. “Not only did the former state insurance commissioner line his pockets off the unnecessary tests, but he also directed another to lie to federal agents to try and cover up the fraud. The FBI will continue to investigate healthcare fraud to ensure those who abuse the system are brought to justice.”
“The sentence imposed today reaffirms our commitment to protecting the integrity of our nation’s health insurance programs from those who illegally profit through fraudulent activities,” said Tamala E. Miles of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG will continue to work closely with our federal law enforcement partners to bring bad actors who defraud our programs to justice.”
“Today’s sentencing should serve as a strong deterrent to those in positions of power who seek to exploit and defraud TRICARE, the military’s healthcare system relied on by our service members, retirees, and their families,” said Special Agent in Charge Darrin K. Jones, Department of Defense (DoD) Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office. “DCIS and our law enforcement partners will aggressively investigate allegations of healthcare fraud that put DoD personnel and their families at risk.”
According to U.S. Attorney Buchanan, the charges and other information presented in court: John Oxendine conspired with Dr. Jeffrey Gallups and others to submit fraudulent insurance claims for medically unnecessary Pharmacogenetic, Molecular Genetic, and Toxicology testing. Physicians associated with Dr. Gallups’ ENT practice were pressured to order these medically unnecessary tests from Next Health, a lab in Texas. As part of Oxendine’s healthcare fraud scheme, Next Health agreed to pay Oxendine and Dr. Gallups a kickback of 50 percent of the net profit for eligible specimens submitted by Dr. Gallups’ practice to the lab company.
In connection with the scheme, Oxendine gave a presentation at the Ritz Carlton in Buckhead, Georgia where he pressured doctors in Dr. Gallups’ practice to order the unnecessary tests. Next Health later submitted insurance claims seeking more than $3 million in payments from private health insurers for the unnecessary tests. The insurance companies paid more than $750,000 to Next Health because of these fraudulent claims. Next Health then paid $260,000 in kickbacks to Oxendine and Dr. Gallups. Some patients were also charged for the tests, receiving bills of up to $18,000.
To conceal the kickback payments, Oxendine and Dr. Gallups arranged for the payments to be made from Next Health to Oxendine Insurance Services, Oxendine’s insurance consulting business. Oxendine used a portion of the kickback money to pay a $150,000 charitable contribution and $70,000 in attorney’s fees for Dr. Gallups.
When a compliance officer at Dr. Gallups’ practice raised concerns about the kickbacks, Oxendine told Dr. Gallups to lie and say the payments were loans. He also directed Dr. Gallups to repeat the lie after he was questioned by federal agents about Next Health. When Oxendine was interviewed about Next Health by the Atlanta Journal-Constitution in connection with a private lawsuit, he falsely denied working with the lab company or receiving money from the business.
John W. Oxendine, 62, of Port St. Joe, Florida, was sentenced by U.S. District Judge Steve C. Jones to three years, six months in prison to be followed by three years of supervised release. He was also ordered to pay restitution in the amount of $760,175.34, and a $25,000 fine. Oxendine was convicted on these charges on March 22, 2024, after he pleaded guilty.
This case is related to United States v. Gallups, criminal no. 1:21-cr-00370-SCJ, in which Dr. Jeffrey Gallups pleaded guilty to health care fraud and was sentenced to 33 months in prison.
