On December 3, 2021, the U.S. Department of Justice (“DOJ”) announced that a federal jury convicted Peter Bolos for his role in a telemedicine pharmacy fraud scheme.  After a month-long trial, Mr. Bolos was convicted of “22 counts of mail fraud, conspiracy to commit health care fraud and introduction of a misbranded drug into interstate commerce,” according to the press release.

According to DOJ, citing court documents and trial evidence, Mr. Bolos, and his co-conspirators deceived and defrauded pharmacy benefit managers (“PBMs”), who processed and approved claims for prescription drugs on behalf of insurance companies, into approving claims valued at more than $174 million.  Mr. Bolos and several co-conspirators owned Synergy Pharmacy in Florida.  Synergy worked with a Florida telemarketer to generate prescriptions for several pharmacies involved in the scheme, including Synergy.  To obtain the prescriptions, the telemarketer used its platform to deceive consumers to accept the drugs and to provide personal insurance information.  The telemarketing service also paid doctors to authorize the prescriptions.  The doctors working with the telemarketing company are accused of authorizing the prescriptions despite not communicating directly with the patient and relying only on the telemarketers’ screening process.

According to the government, “[b]ecause this faulty and fraudulent process made the prescriptions invalid, the drugs were misbranded under the Food, Drug and Cosmetic Act.”  Despite the misbranding, the pharmacies in the scheme dispensed the drugs so Mr. Bolos could submit fraudulent reimbursement claims. The trial evidence established that the conspiracy lasted from May 2015 to April 2018.  During this period, Mr. Bolos paid more than $30 million to buy over 60,000 invalid prescriptions and selected medications that would cause highly profitable reimbursements.  While the conspiracy resulted in $174 million in fraudulently paid billings, Mr. Bolos caused at least $89 million in fraudulently paid billings, according to the government.  

Several co-conspirators and associated business entities previously pleaded guilty.  According to Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services, Office of Inspector General: “[t]his conviction should serve as a warning to individuals who wish to deceive the government and steal from taxpayers. Alongside our law enforcement partners, we will continue to pursue medical professionals who engage in fraudulent activity.”

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with government investigations, including fraud investigations and prosecutions.  If you need assistance with such a matter, please contact us today.