Five people accused of defrauding private and government insurance providers of more than $30 million — including $950,000 from Hamilton County Schools — have been convicted in federal court, the Department of Justice announced Wednesday.
The scheme involved sham prescriptions for topical creams and medications, often issued without the patient's approval, and frequently signed by a health care provider who never met the patient, a news release states.
Jerry Wayne Wilkerson, 40; Michael Chatfield, 31; Kasey Nicholson, 34; Billy Hindmon, 39; and Jayson Montgomery, 40; were all found guilty of health care fraud, wire fraud, mail fraud, illegal kickbacks and money laundering. They were convicted in the United States District Court for the Eastern District of Tennessee at Chattanooga by Judge Harry S. Mattice Jr.
The five are set to be sentenced on June 8.
"Fraud such as this affects everyone," U.S. Attorney J. Douglas Overbey said in a statement. "It increases what we all pay for health care and prescription drugs ... . When people steal from the taxpayers, they steal from all of us."
Prosecutors said the defendants marketed topical creams and other medications through prescription drug coverage plans that paid for the creams and medications. The creams were supposed to be formulated specifically for the needs of an individual patient, which reportedly justified the "exorbitant cost" — sometimes more than $15,000 per tube.
"However, the proof at trial showed there was nothing unique about these creams, and in fact the prescription forms were usually pre-printed documents filled out in mass by the marketers," the news release states. "A health care provider's signature was oftentimes stamped on the document by employees of the defendants."
The four-year federal investigation revealed the defendants convinced friends and family to sign up for revolving shipments of the topical creams and medications, some of which were not medically necessary.
The majority of the time, the medications were neither needed nor wanted by the patient, according to the news release, but "were ordered strictly for monetary gain" and sometimes without the patient's knowledge.
The defendants all profited from the fraud, pocketing of millions of dollars in kickbacks from the prescriptions.