Telemedicine Company Owner Receives 10-Year Prison Sentence for Medicare Fraud Scheme

Telemedicine Company Owner Receives 10-Year Prison Sentence for Medicare Fraud Scheme

On June 30, the US Department of Justice (DOJ) announced that the owner of two telemedicine companies had received a 10-year prison sentence and was directed to pay $66 million in restitution after pleading guilty to participating in a scheme to fraudulently bill Medicare for medically unnecessary orthotic braces and pharmaceutical drugs. Jean Wilson, a nurse practitioner from Richmond Hill, Georgia, operated two telemedicine businesses, Southeastern DME and Choice Care Medical, from 2017 through 2019. On March 5, 2024, Wilson admitted in a plea agreement that she paid approximately $20 to medical professionals per beneficiary for signing orthotic brace orders, often based solely on brief telephonic interactions with beneficiaries or no interaction at all. Wilson also admitted to soliciting and receiving payments of $90 per beneficiary labeled as “medical” and “consultation” expenditures from patient recruiting companies and orthotic brace suppliers in exchange for arranging for the ordering of orthotic braces and prescription drugs for Medicare beneficiaries. Wilson acknowledged that these payments were kickbacks and bribes.

Additionally, Wilson admitted that she and others transferred brace orders to brace providers, patient recruiting companies, and others to support false and fraudulent claims to Medicare. Wilson acknowledged that she used sophisticated means to execute the scheme, including operating across multiple jurisdictions, using shell companies, and putting those companies in the names of nominee owners. Wilson admitted that she and others submitted or caused the submission of false and fraudulent claims to Medicare exceeding approximately $136 million for orthotic braces and prescription drugs that were either medically unnecessary, ineligible for Medicare reimbursement, or not provided as represented. Wilson’s husband, Reinaldo Wilson, previously received a seven-year sentence for his role in the conspiracy.

The case is US v. Wilson, et al, case number 1:20CR00111, in the US District Court for the District of New Jersey (Camden). 

Read the DOJ’s press release here.

AstraZeneca to Pay Nearly $34 Million to Resolve Texas Medicaid Kickback Allegations

On June 29, AstraZeneca agreed to pay approximately $34 million to resolve allegations brought by the State of Texas that the pharmaceutical company provided improper inducements to health care providers to prescribe its medications, many of which were billed to the state’s Medicaid program. Texas Attorney General Ken Paxton alleged that AstraZeneca furnished complimentary nursing services and reimbursement assistance to prescribing physicians and compensated third parties to send nurses and other clinical professionals into provider offices to recommend AstraZeneca products under the pretense of unbranded patient counseling. These practices were allegedly designed to influence providers to prescribe AstraZeneca drugs. Because many of those prescriptions were paid for by Medicaid, the Attorney General’s office contended that the conduct generated millions of dollars in Medicaid claims tied to improper incentives. AstraZeneca denied the state’s claims and entered into the settlement without admitting any wrongdoing.

The state filed suit against AstraZeneca in Travis County District Court under the Texas Health Care Program Fraud Prevention Act (THFPA). The case originated as a qui tam action brought by relators who, according to the complaint, worked with AstraZeneca as a cardiovascular nurse educator and a respiratory care specialist. AstraZeneca will pay $33,998,000 as non-punitive compensation to fully and finally resolve the litigation and the alleged conduct. Texas agreed to distribute a proportionate share of the settlement proceeds to the United States. 

The case is Texas v. AstraZeneca Pharmaceuticals LP, Cause No. D-1-GN-25-011002, in the Travis County District Court of Texas.

The Texas Attorney General’s press release can be found here. 

North Carolina Tax Return Preparation Company Owner and Employees Plead Guilty in $25 Million Pandemic-Relief Fraud Scheme

On June 24, the DOJ announced that Nejlai Mitchell, who operated Unlimited Taxes and More of Lumberton LLC, a tax preparation company in North Carolina, pleaded guilty to preparing fraudulent tax returns and participating in a conspiracy to submit false returns claiming improper COVID-19 tax credit refunds. Mitchell’s plea came after seven other employees at the firm admitted to their participation in the same fraudulent operation. According to the government, between April 2022 and May 2023, Mitchell and the seven employees submitted fictitious tax filings that sought refunds tied to the paid sick and family leave credit, a program enacted by Congress to support businesses affected by the pandemic. The overall conspiracy sought approximately $25 million in allegedly improper refunds, of which the Internal Revenue Service (IRS) disbursed roughly $13.9 million.

Mitchell faces up to five years’ imprisonment for the conspiracy charge and up to three years for filing false returns. Her sentencing is scheduled for September. Mitchell’s co-conspirators are scheduled to be sentenced in the coming months. 

The case is US v. Mitchell, case number 7:26-cr-00038, in the US District Court for the Eastern District of North Carolina.

Read the DOJ’s press release here.