Articles Posted in Health Care Fraud

The Justice Department charged 10 former NFL players, among them a group of former Washington Redskins that includes running back Clinton Portis and cornerback Carlos Rogers, with defrauding a health-care program for retired players of nearly $4 million, according to court documents.

After an FBI investigation, the Justice Department filed charges Thursday morning in the Eastern District of Kentucky against Robert McCune, John Eubanks, Tamarick Vanover, Ceandris Brown, James Butler, Frederick Bennett, Correll Buckhalter, Etric Pruitt, Portis and Rogers.

The government also intends to charge former NFL wide receivers Joe Horn and Reche Caldwell with conspiracy to commit health-care fraud, according to a news release.

The specific combination of charges for the 10 players vary by individual but include conspiracy to commit health-care wire fraud, wire fraud and health-care fraud. Portis was charged with all three. The charges carry a legal maximum penalty of 50 years combined. 

Four former NFL players were arrested Thursday morning, and the others, including Portis, are expected to surrender at some point. The arrested players were McCune in Georgia, Eubanks in Mississippi, Brown in Texas and Rogers in Georgia.

The players allegedly submitted false claims to the Gene Upshaw NFL Player Health Reimbursement Account Plan for reimbursement for medical equipment — such as hyperbaric chambers, cryotherapy machines, ultrasound machines used to conduct women’s health exams and electromagnetic therapy devices designed for use on horses — costing between $40,000 and $50,000. According to the indictments, the players fabricated documents, including invoices and prescriptions, to execute the plan.

Under the terms of the collective bargaining agreement, the Gene Upshaw NFL Player Health Reimbursement Account Plan is funded by NFL teams and jointly administered by the NFL and the NFL Players Association. 

The accused players filed $3.9 million in false claims, and between June 2017 and December 2018, the health plan paid them more than $3.4 million on those claims, according to court documents.

“The expensive medical equipment described in the Reimbursement Request Forms that the Defendants submitted or caused to be submitted to the Plan were never purchased or received from the Participant, and the invoices from medical equipment companies, letters from health care providers, and prescriptions from health-care providers accompanying the Reimbursement Request Forms were all fabricated,” the indictment reads.

According to the indictments, the players fall into two groups: those who recruited former players and helped file fraudulent claims and others who agreed to provide their personal information knowing it would be used to defraud the health-care fund for fellow retired players. The players who filed the fraudulent claims on behalf of others received “payment of kickbacks and bribes” of up to $10,000 for each false claim.

McCune, a linebacker drafted by the Redskins in 2005 who played in the NFL until 2009, allegedly filed the first fraudulent claim. On Oct. 3, 2017, McCune filed a reimbursement claim in Buckhalter’s name for a PEMF 8000 Equine Unit, electromagnetic therapy mobile device used on horses. He also filed a claim for an electromagnetic therapy magnetic mattress and three associated “butterfly loops” at a total cost of nearly $40,000.

Later that month, McCune apparently filed false claims in the names of Eubanks and Brown. Between February 2018 and April 2018, according to the documents, McCune filed another six claims using the names of Vanover, Portis, Butler and Bennett.

On March 8, 2018, McCune filed a false claim under Portis’s name for a “Crome Pro Cryosauna” — a cryotherapy device that looks like a stand-up tanning bed — and a “Sculpting CryoLipolysis,” equipment used for the cosmetic removal of body fat. Combined, the equipment cost more than $54,000, one of the costliest claims noted in the documents.

The documents allege Buckhalter, a running back for the Philadelphia Eagles and Denver Broncos from 2001 to 2010, used the same scheme with the help of Rogers, recruiting new players to file similar reimbursement forms.

McCune and Buckhalter allegedly called the number that handles reimbursement requests and impersonated other players to check the status of false claims submitted on their behalf.

The investigation was triggered, officials said, by health insurer Cigna, which first took notice of suspicious claims.

Benczkowski said the Justice Department pursued the case “because of the potential impact of these crimes — not only the amount of money at stake but the fact that the crimes potentially impacted a very important benefit that was collectively bargained between the league and the players association to benefit former players and their spouses and their dependents.

Health care fraud is a huge government priority at the moment. At this time, it may be the most commonly prosecuted kind of white collar crime in federal court. The Department of Justice and the Department of Health and Human Services’s Office of Inspector General are spending vast resources investigating and prosecuting health care fraud cases.

The majority of healthcare fraud charges arise from fraudulent billing allegations. They can include any sort of the following:

• False billing
• Upcoding (billing a code with a more expensive service)
• Billing for services not rendered
• Billing for unnecessary tests and procedures
• Billing for unnecessary medical equipment
• Double-billing (billing for Medicaid/Medicare and also private insurance)
• Billing for more time than provided
• Kickbacks and referrals
• Falsifying medical records/documents

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