Feds indict 8 on allegations involving fraudulent billing for hemophilia medication
MOBILE, Ala. — A federal grand jury has indicted the owners of a pair of specialty pharmacies on charges that they paid kickbacks to the owner of an Alabama company accused of placing fraudulent orders for expensive hemophilia medication.
The 23-count indictment names 8 defendants and seeks a court order requiring them to forfeit some $29 million in illicit earnings.
“Individuals exhibiting sheer greed through extensive fraudulent billing and awarding improper inducements for Medicaid business, such as the allegations in today’s indictment, are driving up health care costs and are depriving those who really need medical assistance as provided by these government-funded programs,” U.S. Attorney Kenyen Brown said in a prepared statement.
4 separate schemes alleged
Handed down last month and unsealed this week, the indictment lays out 4 separate but related schemes to defraud Alabama Medicaid and Blue Cross and Blue Shield of Alabama.
Lori Skowronski Brill, whose son suffers from hemophilia, founded a hemophilia care company in 2007 that provided free services to blood-clotting disorder patients. The company, Hemophilia Management Specialties Inc., helped patients order their extremely expensive protein replacement medicine called Factor medication froma pair specialty pharmacies: Hemophilia Infusion Managers in Loxley and MedfusionRx in Birmingham.
The indictment alleges that the company, which originally was in Theodore and then moved to Evergreen in 2009, received kickbacks from the pharmacies in exchange for referring customers. The indictment lists six separate kickbacks from the pharmacies totaling $143,486.
Brill, who now works for a Moss Point company that offers intravenous drug therapy, said she is innocent. “I did not do that, and I told them over and over again that I did not do that,” she said.
The indictment names Hemophilia Infusion Managers owners Tony Eric Mosley and James Anthony Goins, as well as Medfusion owners Chris and Jeff Vernon. Jeff Vernon was not available for comment this afternoon, and an employee at the pharmacy said Chris Vernon no longer works there.
Owner learns of indictment from reporter
Mosley said today that he was surprised to learn from a reporter that he had been indicted. He acknowledged paying a commission to Brill but said that she was on his payroll at the time. He said he followed advice from attorneys who said that it was legal to pay commissions as long as the recipient was an employee.
Mosley said he questioned some prescriptions that Brill brought to him, added that he reported his concerns to Blue Cross and Blue Shield.
He said he fired Brill in 2009 after learning that she had stockpiled large amounts of Factor.
“We’ve cooperated with the FBI every time they asked us about Lori Brill,” said Mosley, who added that the indictment likely will finish off a business that has been crippled since Blue Cross and Blue Shield stopped covering patients who use his pharmacy.
Mosley said Factor medication for a typical hemophiliac costs between $250,000 and $500,000 a year.
Mosley said he contacted Brill’s doctor on 2 occasions when he questioned the dose of the medication that she was ordering. One time, he added, the doctor reduced the dosage.
Feds say Brill pressured patients
Brill stands accused of conspiring with Butch Brill, her employee and ex-husband, and 2 others who worked for Hemophilia Management Specialties. Those employees, Ashley Sprinkle and Sherry Demouey, pleaded guilty to health care fraud charges in January. They admitted to falsifying Factor logs to indicate that Hemophilia Management Specialties customers took more Factor medication than they actually did, without verifying the actual usage.
The pharmacies then used the falsified logs to order more Factor medication and then billed Blue Cross Blue Shield of Alabama and Alabama Medicaid, according to plea agreements.
The new indictment accuses Lori Brill of pressuring some Hemophilia Management Specialties customers to re-order unneeded medication and switch to a more expensive brand. The indictment alleges that she forced Sprinkle, who suffers from a blood-clotting disease called Von Willebrand’s disease, to take the medication against her doctor’s instructions during a time when she was trying to get pregnant.
Another patient, Rayford Travis Goodwin, stands accused of enrolling in Alabama Medicaid, even though he lived in Florida and was ineligible to receive benefits from Alabama’s program. Lori Brill, according to the indictment, instructed Goodwin to list her home address on Medicaid documents.
Mosley strongly denied allegations that his pharmacy filled a prescription for Goodwin.
The indictment also accuses Leroy Waters, the patient manager for Medfusion, of receiving $45,155 in illegal kickbacks from the company. The indictment also renewsbankruptcy fraud charges filed against Waters in February. Authorities accuse him of intentionally understating his 2007 Medfusion earnings by $265,885.
He pleaded not guilty this week to the new charges. “The new charges don’t really alter his innocence in this case,” defense attorney Christ Coumanis said.
By Brendan Kirby | firstname.lastname@example.org
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