United States Attorney Maria Chapa Lopez and U.S. Attorney J. Douglas Overbey for the Eastern District of Tennessee have announced that Scott Roix, together with several entities through which he ran his telemarketing business, including HealthRight, LLC; Health Savings Solutions, LLC; Vici Marketing, LLC; and Vici Marketing Group, LLC (hereinafter collectively referred to as “marketing companies”), have agreed to pay $2.5 million to resolve allegations that Roix and these marketing companies violated the False Claims Act by causing the submission of false claims to federal healthcare programs in connection with telemedicine health care fraud schemes.
The government alleged that: (1) Roix and his marketing companies fraudulently obtained insurance coverage information from consumers across the country to arrange for them to receive prescription pain creams and other similar products, (2) these prescriptions were not medically necessary and did not arise from a valid doctor-patient relationship, and (3) Roix and his marketing companies sold these prescriptions to pharmacies under the guise of marketing services, and the payments solicited were based on the volume and value of the prescriptions.
“The United States Attorney’s Office is committed to protecting TRICARE and other federal health care programs from improper practices that harm our nation’s healthcare programs,” said U.S. Attorney Chapa Lopez. “Those who generate prescriptions for profit and violate the Anti-Kickback Statute will be held accountable.”
“Prescriptions and other medical services resulting from kickbacks undermine the integrity of our health care system,” said U.S. Attorney Overbey. “Telemedicine is a valuable service for our citizens, but it must not be abused. We will take action against individuals who break the law to make a profit at the expense of our federal healthcare programs and ultimately at the expense of the American taxpayer.”
“Telemarketing fraud is a major threat to the integrity of the Medicare program,” said Derrick L. Jackson, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta. “Unscrupulous companies collect patient information then sell it to pharmacies and other medical providers in exchange for kickbacks.”
U.S. Postal Service Office of Inspector General Special Agent in Charge Kenneth Cleevely, Eastern Area Field Office, stated, “The U.S. Postal Service spends billions of dollars per year in workers compensation-related costs, most of which are legitimate. However, when medical providers or companies choose to flout the rules and profit illegally, special agents with the USPS OIG will work with our law enforcement partners to hold them responsible. To report fraud or other criminal activity involving the Postal Service, contact our special agents at www.uspsoig.gov or 888-USPS-OIG.”
“This settlement demonstrates the commitment of the Defense Criminal Investigative Service and our law enforcement partners to ensure that individuals do not unjustly enrich themselves by abusing the Department of Defense TRICARE program. DCIS protects the integrity of DoD programs by rooting out fraud, waste, and abuse which diverts American taxpayer dollars intended to support our Warfighters,” said Special Agent in Charge, Cyndy Bruce, Southeast Field Office.
“Today’s settlement demonstrates the commitment of the Office of Personnel Management Office of the Inspector General and our law enforcement partners at the Department of Justice to ensuring that federal health care programs, including the Federal Employees Health Benefits Program, are protected from fraud and abuse,” said Thomas W. South, the OPM Deputy Assistant Inspector General for Investigations. “I am immensely proud of the work our office has done to not only safeguard taxpayer dollars, but also protect the health and wellbeing of federal employees, annuitants, and their families.”
“This settlement emphasizes the collaborative effort by the FBI and our law enforcement partners to target those individuals who cheat the system and destroy public trust in our federally funded healthcare programs,” said Michael F. McPherson, Special Agent in Charge of the FBI Tampa Division.
The settlement resolves allegations that, beginning in September 2014, Health Savings Solutions, at the direction of Roix, received payments from Oldsmar Pharmacy that were based on the value and volume of prescriptions solicited by Health Savings Solutions in violation of the Anti-Kickback Statute, and the False Claims Act. These allegations were brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. The qui tam case against Roix and Health Savings Solutions was filed by Jennifer Silva and Jessica Robertson and is captioned: United States ex rel. Silva, et al. v. Vici Marketing, LLC, et al., Middle District of Florida (Case No. 8:15-cv-444-T-33TGW). Ms. Silva and Ms. Robertson will receive $287,500 of the settlement.
The settlement also resolves allegations that, from June 2015 through October 2018, HealthRight, at the direction of Roix, received payments from Synergy Pharmacy that were based on the value and volume of prescriptions solicited by HealthRight on behalf of Synergy Pharmacy. These allegations were also the subject of a criminal case captioned United States v. Scott Roix, et al., Eastern District of Tennessee (Case No. 2:18-cr-133), in which Roix and HealthRight pleaded guilty in September 2018.
This investigation was a collaborative effort between the U.S. Attorneys’ Office of the Eastern District of Tennessee and the Middle District of Florida. It was handled by Assistant U.S. Attorneys Jeremy Dykes, Michael Kenneth, and Jessica Sievert, with support from HHS-OIG, OPM-OIG, USPS-OIG, DOD-DCIS, and FBI.
The claims resolved by this settlement are allegations only, and there has been no determination of liability.
This is a press release from the US Department of Justice.