The U.S. Department of Justice has reported the conviction of a Chief Compliance Officer in a massive Medicare fraud scheme.  According to the DOJ’s press release, a high-ranking healthcare executive, Steven King, was found guilty of orchestrating a fraudulent scheme that defrauded the Medicare program of a staggering $50 million.

Mr. King was the chief compliance officer of a pharmacy holding company that held pharmacies in various states.  These pharmacies filled scripts for medically unnecessary lidocaine and various diabetic testing supplies, according to the government.  The government also noted that “King was in a unique position to prevent and report the fraudulent scheme, but he used his position to defraud Medicare instead.”  According to the government, Mr. King and his co-conspirators tried to conceal their scheme by enrolling their pharmacies as brick-and-mortar pharmacies, despite their pharmacies actually being mail order pharmacies.  Mr. King and his co-conspirators also transferred patients amongst pharmacies without patients consenting to the transfers.  According to the government, Mr. King took these steps to ensure the patients continued to be billed for profitable medications and supplies.  For his actions, Mr. King was convicted of conspiracy to commit health and wire fraud.  He faces up to 20 years in prison.

The conviction shows the government’s commitment to combating healthcare fraud.  This case highlights the importance of robust compliance programs within healthcare organizations to prevent and detect fraudulent activities.  The government continues to pursue schemes and individuals who seek to undermine the integrity of the Medicare program, diverting resources from those in genuine need of medical care.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection with white-collar criminal investigations and false claims allegations.  If you need help with such a matter, please contact us today.