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Free is Not Free

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Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

When something is advertised as “free,” it usually comes with a cost. Unfortunately, a few members of the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) found this out the hard way due to a Grand Blanc, Mich., man’s healthcare scam that stole millions of dollars from multiple healthcare insurance providers.

Patrick Wittbrodt, 46, supervised the complex fraud and kickback scheme involving the dispensing of medically unnecessary compounded pain creams, scar creams, pain patches and vitamins. He and his cronies caused a loss of $8,000,000 to Medicare and Blue Cross Blue Shield of Michigan. (Some of that money was stolen from the UAW members’ prescription insurance accounts.)

Fraudsters typically choose pain and scar creams, pain patches and vitamins because of the high reimbursement rates paid by insurance plans. In this particular case, Wittbrodt and his co-conspirators scheduled time to tout these commodities at UAW meetings. During the presentation, the members were told they would receive their prescriptions for free, without any need for a copay at the pharmacy. (Obviously, UAW members who agreed to participate didn’t realize they would be part of a fraud scheme that stole millions of dollars.)

Once a UAW member agreed to receive the “free” prescriptions, Wittbrodt and his co-conspirators collected insurance information. Court documents show that Dr. April Tyler authorized the prescriptions for the UAW members and their family members even though she never performed a physical exam or determined the prescriptions were medically necessary. (That would make the claims not eligible for reimbursement from the insurance providers.)

Dr. Tyler pre-signed the prescription forms so the co-conspirators could choose which prescription was wanted based on the UAW member’s preference. (How thoughtful of her to do that.) Wittbrodt sent the prescriptions to multiple pharmacies, which would fill the prescriptions, bill the UAW members’ insurance provider, and pay a kickback to him. (Then Wittbrodt shared his take with his co-conspirators.)

To make even more money, the prescriptions were often re-filled and re-billed, whether a refill was requested or not. Again, the copay was waived, and the insurance providers picked up the tab.

Wittbrodt was sentenced to 48 months in prison, then two years of supervised release for committing healthcare fraud. He was also ordered to pay $7,317,173.51 in restitution to Blue Cross Blue Shield of Michigan and another $902,387.93 in restitution to Medicare. He also agreed to forfeit around $72,000 seized by federal agents. (That should serve as a signal to scheming medical professionals and others that the FDA will investigate and bring to justice those involved in the illegal distribution of prescription drugs.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Grand Blanc Man Sentenced to 48 Months In Prison After Pleading Guilty to Fraud, Kickback Violations Involving UAW Health Care Fraud,” dated November 2, 2021.

A Grand Blanc, Michigan man was sentenced to 48 months in prison after having pleaded guilty to supervising a complex fraud and kickback scheme involving UAW members and medically unnecessary compounded pain creams, scar creams, pain patches and/or vitamins, announced Acting United States Attorney Saima Mohsin.

Mohsin was joined in the announcement by Special Agent in Charge Lynda M. Burdelik, FDA Office of Criminal Investigations Chicago Field Office and Mario M. Pinto, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General.

 

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