LARGO — A Largo telemarketer and several of his companies have agreed to pay $2.5 million to settle allegations from whistleblowers that they took part in a scheme to help pharmacies seek Medicare and Medicaid payments of up to $25,000 for pain medicines that retailed for less than $10.
Federal prosecutors say Scott Roix, 53, and his telemarketing companies, HealthRight, Health Savings Solutions and Vici Marketing, fraudulently obtained insurance coverage information from consumers across the country, then arranged for doctors in New Jersey, Tennessee, South Carolina and Michigan to write them prescriptions for pain creams, gels and patches, usually without communicating with the patients at all.
The drugs were medically unnecessary, authorities say, and the prescriptions did not result from a valid doctor-patient relationship. Roix’s companies then sold the prescriptions to pharmacies under the guise of providing marketing services. Starting in September 2014, authorities say, Health Savings Solutions received kickbacks from Oldsmar Pharmacy based on the value and volume of prescriptions it delivered.
In federal court pleadings filed this spring, attorneys for Oldsmar Pharmacy denied the government's allegations point by point. They acknowledged that the pharmacy's owner, Larry Smith, had another company that had an administrative services and marketing agreement with Health Savings Solutions. But they said the pharmacy did not pay Roix's company commissions or make payments that were otherwise illegal, nor did it know how Roix's companies did business or handled customers. And they denied that the only work that Health Savings Solutions did was to generate prescriptions for which the pharmacy could seek reimbursement.
Reached Friday while traveling abroad, Roix's attorney in the case, Jason Mehta of Tampa, said he was not in a position to comment on the settlement.
In addition to Medicare and Medicaid, authorities said the scam affected the federal Tricare health insurance program, which covers active duty military personnel, family members and military retirees.
“Telemarketing fraud is a major threat to the integrity of the Medicare program,” Derrick L. Jackson, special agent in charge at the Atlanta Office of Inspector General for the U.S. Department of Health and Human Services, said in an announcement of the settlement. “Unscrupulous companies collect patient information, then sell it to pharmacies and other medical providers in exchange for kickbacks.”
The allegations were brought to the government’s attention through a federal whistleblower lawsuit filed by Jennifer Silva, who did data entry and patient credentialing for a company that did business as the Oldsmar Pharmacy, and Jessica Robertson, who worked in credentialing for a health care company not owned by Roix that was initially included in the lawsuit but later dismissed from it. As a result of their role in exposing the fraud, prosecutors said, the women will receive $287,500 of the settlement.
In their suit, Silva and Robertson said Roix's companies would get names of patients with conditions that included chronic pain. The companies called the patients to market pain medications and get information about their government health insurance coverage. After doctors wrote prescriptions, a participating pharmacy would seek authorization from Medicaid, Medicare or Tricare for the pain medication and would "regularly seek and receive" $5,500 to $25,000 per prescription for a medication with an actual retail cost of less than $10, the whistleblowers said. After getting paid, according to the suit, the pharmacy would send 60 percent of the profit to Roix's Vici companies.
The settlement also resolves allegations that HealthRight, at Roix's direction, received payments from 2015 to 2018 from a second pharmacy. Roix and HealthRight pleaded guilty last September to criminal allegations arising from those kickbacks and are scheduled to be sentenced on Feb. 10.
Contact Richard Danielson at firstname.lastname@example.org or (813) 226-3403. Follow @Danielson_Times