A federal judge sentenced three people for running a scheme to overbill Alabama Medicaid this week.
The defendants were Travis Goodwin, Lori Skowronski Brill, and her husband Butch Brill.
Brill ran a patient advocacy business named Hemophilia Management Specialties near Theodore Alabama. Through her contact with patients Brill would convince them to tell doctors that they needed more medication than actually necessary. The patients would then order their medications from two local pharmacies involved in the scheme. Medicaid and private insurance would pay the pharmacies for the medication and the pharmacies would give Brill a percentage of the money from the insurers.
Goodwin is a patient with hemophilia who followed a plot by Lori Brill to request more medication than necessary from his doctor.
Goodwin was sentenced to 3 years of supervised release. He had little connection the conspiracy. As U.S. attorney Adam Overstreet observed, Goodwin received virtually no benefit form the fraud and was only a pawn in Brill’s scheme.
Besides Goodwin, prosecutors say that Brill had her relatives engage in the scheme as well.
Federal authorities alleged that the scheme wasted taxpayer money and medication. In testimony at trial prosecutors showed that the FBI found approximately 300,000 units of the medication spoiling in Brill’s garage.
Brill made approximately $191,182 from the illegal scheme; which cost Alabama Medicaid roughly $2.1 million from September 2007 to August 2009. The pharmacies involved made approximately $424,839 on the medication.
Prosecutors say that Brill used $20,000 of the Medicaid kickback money to purchase a truck for her husband, Butch, who also worked at Hemophilia Management Specialties. Butch’s attorneys argued that he should be exempt from prosecution because he knew nothing about how his wife was being paid. However, Butch was sentenced to 15 months in prison for involvement in the scheme. Although, his attorney said that Butch would appeal the decision.
Medicaid fraud schemes like Brills are multi-billion dollar problems. In response the U.S. government has escalated their enforcement mechanisms by establishing qui tam whistle blower provisions in false government claims law. The qui tam provision allows persons with evidence of fraud in government contracts or programs to sue on behalf of the government to recover stolen funds.
Types of fraud that can be prosecuted under the qui tam provision of the false claims act include schemes like Brill’s where the following take place:
- Billing the government for goods and services never delivered.
- Submitting false records to show better than actual performance.
- Performing inappropriate or unnecessary medical procedures to increase Medicare reimbursement.
- Charging more than once for the same goods or service.
- Inflating bills by using billing codes that suggest a more expensive treatment or illness.
- Billing for unlicensed or unapproved drugs.
- Forging physician signatures when a signature is required for a Medicare or Medicaid reimbursement.
Cases like Brill’s represent the increased oversight on government funded programs and special investigations of health care fraud designed to prosecute medical professionals, and individuals like Brill from unjustly profiting off tax payer money.