Jacksonville药房老板被控5100万美元医保诈骗：以免费手机套取个人信息、开出数万份虚假HIV药物处方
位于佛罗里达州 Jacksonville 的 First Coast Community Development（FCCD）负责人 Charlie Bernard Griffin III（61岁）被联邦大陪审团以31项罪名起诉，罪名涉及医保诈骗与洗钱；同案的会计师 Ethelbert Chinenye Nwanegbo（47岁，St. Johns）被控洗钱。美国佛罗里达中区联邦检察官办公室宣布了这份起诉书，联邦检察官 Gregory W. Kehoe 表示，两名被告每一项罪名最高可判20年监禁。起诉书于10月29日起诉、近日公开，检方在11月12日的发布中公布了案情。
起诉书指控，Griffin 旗下的 FCCD 在 Jacksonville 经营一家药房，并与 Jonathan Gholston 拥有的一家营销公司签约，由该公司把人转介到 FCCD 领取 HIV 暴露后预防药物。营销人员在 Jacksonville 多以低收入社区为主支起帐篷和桌子，以提供免费的政府资助手机为名，让停下脚步的居民提供身份信息；在办理手机所需信息的同一过程里，他们还套取了对方的医保信息，包括其参加的是 Medicare、Medicaid 还是私人保险。
按双方约定，FCCD 每转介一名领取 HIV 药物的人，就向营销公司支付200美元，前提是就该人提交的索赔获得医保方付款；营销公司再按每人通常50美元付给一线营销人员，同样以索赔获付为条件。起诉书指出，这种按转介人数、且与索赔是否获付挂钩的付费，属于非法回扣。
起诉书还指控，营销人员收集的信息被送到 FCCD 及其药剂师 Albert Chester 处，FCCD 据此生成 HIV 药物处方，开方者是执业护士 Rashan Jones，而 Jones 从未见过、联系过或以任何方式评估、检查过这些被开方的人。为确保索赔获付，FCCD 在这些人的病历中虚假使用了一个表示其感染或暴露于 HIV 或性传播疾病的诊断代码。FCCD 配药后向 Medicare、Medicaid 或私人保险公司提交索赔并获得报销。
检方称，Griffin 及其同伙的行为导致数万份虚假索赔被提交，Medicare、Medicaid 与私人保险公司合计报销约5100万美元，Griffin 本人从中获得约1400万美元收益。起诉书通知 Griffin，政府正寻求没收其诈骗所得14,245,474美元、涉洗钱财产17,807,628.14美元，另寻求没收已从其银行账户扣押的8,182,800.17美元，以及其用诈骗所得购置的三处房产和四辆汽车。对 Nwanegbo，政府寻求没收涉洗钱财产6,068,540.50美元；起诉书指控他把诈骗所得在自己控制的账户之间转移、留取约10%的洗钱费用后，再以转账和现金方式返还给 Griffin 一方。
Gholston、Chester 与 Jones 此前已被分别起诉，三人均已同意认罪。本案由美国卫生与公众服务部监察长办公室（HHS-OIG）、联邦调查局（FBI）与国税局刑事调查局（IRS-CI）调查，联邦助理检察官 Arnold B. Corsmeier 负责起诉。起诉书只是指控，两名被告在法庭证明有罪之前均被推定无罪。
（来源：美国司法部）
Jacksonville Pharmacy Owner Indicted in $51 Million Health Care Fraud Scheme Involving Free-Cellphone Lure and False HIV Prescriptions
Charlie Bernard Griffin III, 61, of Jacksonville, Florida, who owned First Coast Community Development (FCCD), has been charged in a 31-count federal indictment with health care fraud and money laundering, the U.S. Attorney's Office for the Middle District of Florida announced. Ethelbert Chinenye Nwanegbo, 47, of St. Johns, was charged in the same indictment with money laundering. U.S. Attorney Gregory W. Kehoe made the announcement. Each defendant faces a maximum penalty of 20 years in prison on each count. The indictment was returned on October 29 and announced by prosecutors on November 12.
According to the indictment, FCCD operated a pharmacy in Jacksonville and entered into an agreement with a marketing company owned by Jonathan Gholston to refer people to FCCD for HIV post-exposure prophylactic medications. Representatives of the marketing company set up tents and tables in Jacksonville, generally in low-income areas, and offered free, government-sponsored cellphones to anyone who stopped and provided identifying information. While obtaining the information needed for the cellphone, the representatives also obtained health insurance information, including whether the person was covered by Medicare, Medicaid, or a private insurer.
The agreement provided that FCCD would pay the marketing company $200 for every person referred for HIV medications, but only if a claim submitted on that person's behalf was paid. The marketing company paid its representatives a set amount, usually $50, for every person referred, again only if a claim was paid. The indictment states that being paid per referral based on whether a claim is paid is an illegal kickback.
The information gathered was sent to FCCD and its pharmacist, Albert Chester. FCCD used it to generate prescriptions for HIV medications authorized by Rashan Jones, a nurse practitioner who had never seen, spoken with, or performed any evaluation, examination, or test on the people for whom the prescriptions were issued. To ensure the claims were paid, FCCD falsely used a diagnosis code indicating that the person had, or had been exposed to, HIV or a sexually transmitted disease, and that false diagnosis was documented in the person's medical records. FCCD filled the prescriptions and submitted claims to Medicare, Medicaid, or private insurers.
Prosecutors say the scheme caused the submission of tens of thousands of fraudulent claims, resulting in reimbursements from Medicare, Medicaid, and private insurers totaling approximately $51 million. Griffin received approximately $14 million in proceeds. The indictment notifies Griffin that the United States is seeking forfeiture of $14,245,474 in fraud proceeds and $17,807,628.14 in property involved in the money laundering offenses, along with $8,182,800.17 seized from his bank accounts and three real properties and four vehicles purchased with fraud proceeds. For Nwanegbo, the government is seeking forfeiture of $6,068,540.50; the indictment alleges he moved proceeds through accounts he controlled, retained a money laundering fee of approximately 10 percent, and returned the funds to Griffin and a co-conspirator.
Gholston, Chester, and Jones were previously charged separately, and each agreed to plead guilty. The case is being investigated by the U.S. Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, and IRS Criminal Investigation, and is being prosecuted by Assistant United States Attorney Arnold B. Corsmeier. An indictment is only an accusation, and both defendants are presumed innocent unless and until proven guilty in court.
(Source: U.S. Department of Justice)
来源：美国司法部
发布：GSM·美国（发布链接）
图片来源：图：位于华盛顿的美国司法部总部大楼（资料图）。美国之音摄，公共领域。 / Photo: U.S. Department of Justice headquarters in Washington (file photo). By Voice of America, public domain.
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