Michael Scott Burton, 52, of Decatur, Georgia, was sentenced to 96 months in federal prison last week after he pleaded guilty to charges of conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and money laundering.
The sentence was announced today by Lawrence Keefe, United States Attorney for the Northern District of Florida.
Between January 2014 and December 2015, Burton conspired with others to defraud TRICARE and other insurance companies out of more than $6.5 million in fraudulent claims for prescriptions for compounded pain cream, scar cream, and wellness capsules.
Burton agreed that co-defendant Brad T. Hodgson would forge prescriptions for compounded drugs for individuals who Burton knew were not patients of the Georgia doctor’s practice where Hodgson worked.
Burton recruited sales representatives, including co-defendants Bradley D. Pounds and Heather E. Pounds, to obtain and provide Burton with the personal identifying information and insurance cards of individuals for whom the prescriptions could be issued in exchange for commission payments.
Burton would forward that information to Hodgson, who would issue the prescriptions – even though he was not licensed to write prescriptions – and send them to Physician Specialty Pharmacy in Pensacola without the individuals ever seeing or speaking with a doctor.
Burton also recruited co-defendant Marie Ann Smith to assist Hodgson with processing and submitting prescriptions.
Physician Specialty Pharmacy then caused TRICARE and other insurance companies to be billed and paid Burton a 50% commission for each compounded drug prescription that was paid by insurance. By this conduct, Burton earned over $1.4 million in commissions from fraudulent prescriptions.
“Health care fraud is a crime that affects all Americans – but to perpetrate a scam that victimizes a program for our nation’s service members and their families is beyond appalling,” Keefe said.
“This conspiracy stole money meant to help those who have given so much to our nation, and the criminals behind it deserve the punishment they receive.”
“The wide-spread corruption uncovered in this complex and multistate fraud scheme wasted millions of American taxpayer dollars, and furthermore, deprived U.S. military members and their families of legitimate prescription medications and other needed medical care,” said Cynthia A. Bruce, Special Agent in Charge, DCIS-Southeast Field Office.
“DCIS is committed to working with our investigative partners and the U.S. Attorney’s Office to identify, investigate and bringing to justice anyone who defrauds the DoD and the American taxpayer.”
For his role in the scheme, Burton was sentenced to 96 months in prison. He was also ordered to pay $$6,540,348.48 in restitution to TRICARE and pay a forfeiture money judgment of $1,480,931.74.
In February, Bradley Pounds was sentenced to 21 months in prison, and Smith and Heather Pounds were sentenced to probation.
In separate related cases, Hodgson is awaiting sentencing after pleading guilty, and Andrew E. Fisher, the president and part-owner of Physician Specialty Pharmacy, is awaiting trial scheduled for September 3rd.
“Crimes like this increase the costs we all pay for healthcare and prescription drugs,” said FDLE Commissioner Rick Swearingen.
“I thank our FDLE Pensacola office for spearheading this complex investigation and our U.S. Attorney’s Office for prosecuting this case.”
Assistant United States Attorney Alicia H. Forbes prosecuted these cases following an investigation by the Federal Bureau of Investigation, Defense Criminal Investigative Service, Florida Department of Law Enforcement, Florida Department of Financial Services-Bureau of Insurance Fraud, Florida Department of Health, Naval Criminal Investigative Service, and Army Criminal Investigative Command.
The United States Attorney’s Office for the Northern District of Florida is one of 94 offices that serve as the nation’s principal litigators under the direction of the Attorney General.
To access public court documents online, please visit the U.S. District Court for the Northern District of Florida website.
This is press release from the US Department of Justice.