Category Archives: Healthcare Fraud

Telemedicine Business Owner Pleads Guilty to Fraud

Scott Gregory Roix, owner of the telemedicine company HealthRight, pleaded guilty to conspiracy to commit health care and wire fraud. Roix and his four alleged conspirators, Florida and Texas pharmacists and pharmacy owners are accused of submitting fraudulent insurance claims for more than $930 million.

Healthright made a lot of money illegally selling suspect, inexpensive drugs like weight-loss pills, skin creams and testosterone supplements at inflated prices. Roix’s company also obstructed doctor-patient relationships with telemarketers posing as “medical personnel.” HealthRight hid drug sales to the partner pharmacies by accounting for the payments as “marketing services.”

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Tampa Bay Businessmen Indicted in Billion Dollar Insurance Fraud Scheme

Four Pinellas County businessmen, Andrew Assad, Peter Bolos, Michael Palso and Larry Everett Smith have been indicted on charges of conspiracy to commit health care fraud, mail fraud and introducing misbranded drugs into interstate commerce. The conspiracy involved using their telemedicine business called HealthRight and compounding pharmacy companies to deceive patients, doctors, insurance carriers by fraudulently soliciting insurance coverage information and prescriptions, mark up the prices of the invalidly prescribed drugs, and bill insurance carriers. One of the compounding pharmacies, Alpha-Omega in Clearwater, allegedly charged $374 for $35-worth of lidocaine – a 969-percent markup.

According to the indictment, the men defrauded Blue Cross Blue Shield of Tennessee out of approximately $174,000,000. Another Bay area man, Scott Roix, already please guilty to felony conspiracy in this case and another case involving wire fraud. Assad, Bolos, Palso, and Smith could face prison terms of over 30 years, fines up to $250,000 and probation for their charges.

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Clearwater Doctor Pleads Guilty to Medicare Fraud

Dr. Jayam Krishna Iyer of Clearwater accepted a plea agreement that will end her medical career. Iyer’s charges include defrauding Medicare by billing for treatments she never delivered and giving written prescriptions for Schedule II narcotics to relatives of patients who never actually stepped foot into her offices.

Iyer’s controversial past includes being sued for malpractice in civil court. She has also been named in death investigations involving narcotics including dilaudid, morphine, oxycodone and fentanyl that she prescribed between 2003 and 2017 in Pinellas County.

Iyer will have to pay $51,000 in restitution for Medicare fraud in addition to giving up her medical career. She was facing up to 10 years in prison and as much as $250,000 in fines, will get a reduced sentence in exchange for her guilty plea.

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Doctor Sent To Prison For Obstructing Medicare Audit

Dr. John Janick of Port Charlotte was sentenced to five months in prison and three years of parole for lying to during a Medicare audit. Dr. Janick lied to a Medicare program integrity contractor about office space that was being utilized by his wife Lisa McLaren Janick who was found guilty of health care fraud in another related case. Mrs. Janick used the office to gain access to sensitive patient data and generate bogus patient referrals from the Janick Medical Group to her third-party employer.

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Vero Beach Acupuncturist Charged with Insurance Fraud and Racketeering

Jill Jaynes of Absolute Integrated Medicine in Vero Beach has been arrested and charged with insurance fraud totaling nearly $1.5 million, racketeering and more. If Jaynes is convicted, she could face up to 135 years in prison and millions of dollars in fines.

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Filed under Healthcare Fraud, Insurance, Insurance Fraud

Owner of Medical Billing Company Pleads Guilty to Healthcare Fraud Scheme

According to the report, Billings USA received or created fabricated bills for its clinic customers. The clinics would then bill insurance companies for allowable amounts and create records to back up the charges.  Billings USA collected a 6% fee on the reimbursement from insurers. Palma’s company filed $5.7 million in fraudulent claims to Blue Cross Blue Shield with one clinic and then an additional $5.9 million in fraudulent claims to Blue Cross and Cigna with another clinic.

Mauricio Palma, the owner of medical billing office Billing USA in Miami, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to eight years in prison. Palma faces $2.1 million in restitution lost $1.8 million in forfeiture.

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