16 accused of $175 million insurance fraud

16 accused of $175 million insurance fraud

16 accused of $175 million insurance fraud The U.S. Attorney’s Office for the Southern District of Florida released a statement Thursday announcing that 16 medical professionals across the country—11 of which are based in South Florida—have been charged in a $175 million insurance fraud scheme.

The scheme involved the manufacture and distribution of compounded medications, misrepresentations to health insurance providers, kickbacks, and other fraudulent activity, the release mentioned.

According to the release, the defendants participated in a two-year conspiracy under assumed business entities—namely, Numed Care, LLC, ClinicalCorp, LLC, RX of Boca, and American Custom Compound Pharmacy—to perpetrate fraud.

“The defendants prepared medications in bulk quantities which were alleged to be compounded medications for specific individualized patient needs,” the release detailed. “The defendants falsely represented to the health insurance providers that these medications were prepared in limited quantities for individual patients and were exempted from FDA inspection.”

Health insurance providers, in turn, compensated the defendants for the purported cost of the medications’ ingredients, the release further detailed. The defendants, however, did not tell the providers that illegal kickbacks to physicians were made for the issuance of the compounded medications. Allegedly, the defendants illegally provided physicians with pre-printed prescription pads.

Related stories:
Three Oklahoma men charged with workers’ comp, insurance fraud
Three arrested in Miami following insurance fraud probe