The chief compliance officer of a pharmacy holding company will serve more than four years in prison and must pay $21.7 million in restitution, the Department of Justice (DOJ) announced.
A Florida man was sentenced this week for his role in a health care fraud and wire fraud conspiracy for submitting more than 50 million in false and fraudulent claims to Medicare. In June, he was convicted of conspiracy to commit health care fraud and wire fraud.
DOJ announced that Steven King, 45, of Miramar, was the chief compliance officer of a pharmacy holding company that fraudulently billed Medicare for dispensing lidocaine and diabetic testing supplies that Medicare beneficiaries did not need or want. He will serve 4 ½ years in prison and must pay 21.7 million in restitution.
King, along with his co-conspirators, operated A1C Holdings LLC, a holding company for pharmacies in various states, including All American Medical Pharmacy in Warren, Mich. These pharmacies secured prescriptions and refills for medically unnecessary prescriptions for lidocaine and diabetic testing supplies, in violation of Medicare’s rules and regulations, as well as the pharmacy benefit managers’ rules and regulations with which the pharmacies had contracts.
The Justice Department said King and his co-conspirators took several steps to conceal their scheme, including enrolling their mail order pharmacies as brick-and-mortar retail pharmacies to evade more rigorous oversight, shipping prescription refills for high-reimbursing medications and supplies without patient consent, concealing the ownership of A1C Holdings LLC and its pharmacies, and transferring patients between these pharmacies without patient consent. Each step ensured that they could bill Medicare for profitable medications and supplies, like lidocaine and diabetic testing supplies.
Since March 2007, the Health Care Fraud Strike Force Program has charged more than 5,400 defendants who collectively have billed federal health care programs and private insurers more than $27 billion. The Centers for Medicare & Medicaid Services, working in conjunction with the Department of Health and Human Services-Office of Inspector General, are taking steps to hold providers accountable for their involvement in health care fraud schemes.