A 52-year-old Hattiesburg man was among 11 people charged in a three-state federal health care fraud investigation in which he allegedly received kickbacks on fraudulent prescriptions that amounted to more than $510 million.
Wade Ashley Walters is a co-owner of numerous compounding pharmacies and pharmaceutical marketing companies. In March, Walters pleaded guilty on behalf of his company, CFK. The company was convicted of one count of conspiracy to commit false claims, was fined $25,000 and ordered to repay almost $622,000.
This week, Walters was charged for his alleged role in a scheme to defraud TRICARE and other private health insurance companies by paying kickbacks to practitioners and marketers for the prescribing and referring of fraudulent prescriptions for medically unnecessary compounded medications.
TRICARE is a health insurance program for members and veterans of the armed forces and their families.
Those 11 people charged in the fraud included physicians, licensed social workers, as well as other medical and business professionals. In addition, in Louisiana, 22 defendants – including 19 certified mental and home health professionals – have been charged with defrauding Medicaid out of approximately $300,000. Louisiana’s Medicaid Fraud Control Unit investigated these cases.
Assistant Attorney General Brian A. Benczkowski
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division said various schemes were used by the 11 people to defraud Medicare, Medicaid, and TRICARE and to obtain oxycodone and other controlled substances by fraud.
The conduct allegedly resulted in more than $515 million in fraudulent billings.
The enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force partners, a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI, the Drug Enforcement Administration and U.S. Health and Human Services-Office of Inspector General. In addition, the operation includes the participation of IRS-Criminal Investigations, Mississippi Bureau of Narcotics and various other federal law enforcement agencies and state MFCUs.
U.S. Attorney Mike Hurst, U.S. Southern District
U.S. Attorney Mike Hurst of the Southern District of Mississippi said, “Healthcare fraud harms us all. When individuals put their greed above the interests and well-being of our men and women in uniform and our veterans, this office will be there to swiftly bring them to justice.”
In the Southern District of Mississippi, two defendants in addition to Walters were charged:
Gregory Auzenne, M.D., 49, of Meridian was charged for his alleged participation in a scheme to defraud TRICARE and other private health insurance companies by prescribing medically unnecessary compounded medications in exchange for kickbacks and bribes. The indictment alleges that Auzenne was involved in more than $1.6 million in fraudulent claims to TRICARE.
Tiffany Clark, 45, of Meridian was charged for her alleged participation in a scheme to defraud TRICARE and other private health insurance companies by prescribing medically unnecessary compounded medications in exchange for kickbacks and bribes. The indictment alleges that Clark was involved in more than $1.6 million in fraudulent claims to TRICARE.
In the Middle District of Louisiana, three defendants have been charged:
J. Foster Chapman, D.O., 40, of Alexandria, was charged for his alleged participation in a scheme to prescribe medically unnecessary durable medical equipment, namely orthotics, to Medicare beneficiaries whom he never examined and in the absence of any doctor-patient relationship. More than $4.8 million in fraudulent Medicare claims were filed, according to the indictment.
Victor Clark Kirk, 70, of Baton Rouge, the former CEO of a federally qualified health center, was charged for his alleged role in a scheme to defraud Medicaid. Specifically, the indictment alleges that Kirk directed employees to falsely diagnose students with significant mental health disorders and subsequently submit false claims to Medicaid falsely claiming that psychotherapy services were provided, when in fact they were not. According to the indictment, during the relevant time period, the health center’s claims for purported group psychotherapy services totaled more than $1.8 million.
Marilyn Brown Antwine, 51, of Baton Rouge, the former COO of a federally qualified health center, was charged for her alleged role in a scheme to defraud Medicaid. Specifically, the indictment alleges that Antwine directed employees to falsely diagnose students with significant mental health disorders and subsequently submit false claims to Medicaid falsely claiming that psychotherapy services were provided, when in fact they were not. According to the indictment, during the relevant time period, the health center’s claims for purported group psychotherapy services totaled more than $1.8 million.
In the Eastern District of Louisiana, two defendants have been charged.
Aaron Denn, 34, of Metairie, was charged for his alleged role in a scheme to obtain and divert oxycodone pills to the black market.
Christie Lynn Browning, 40, of Metairie, was charged for her alleged role in a conspiracy to obtain oxycodone by fraud and to then distribute those oxycodone pills.
In the Northern District of Florida, two defendants have been charged.
Helen Elizabeth Storey, 37, of Tallahassee, the owner of a Tallahassee-based counseling center, was charged for her alleged participation in a scheme to defraud Medicaid by submitting false and fraudulent claims for purported behavioral health services, including psychotherapy, that were not provided. According to the indictment, about $250,000 in false and fraudulent claims were filed to Medicaid.
Stephanie Lynn Fleming, 42, of Tallahassee, a licensed mental health counselor at a Tallahassee-based counseling center, was charged for her alleged participation in a scheme to defraud Medicaid by submitting false and fraudulent claims for purported behavioral health services, including psychotherapy, that were not provided. According to the indictment, about $250,000 in false and fraudulent claims were filed to Medicaid.
The charges and allegations contained in the indictments are merely accusations. The defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.
Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.
In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.