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Sunday, November 7, 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.
Department of Justice
U.S. Attorney’s Office
Eastern District of Michigan
FOR IMMEDIATE RELEASE
Tuesday, November 2, 2021
Grand Blanc Man Sentenced to 48 Months In Prison After Pleading Guilty to Fraud, Kickback Violations Involving UAW Health Care Fund
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
Sentenced was Patrick Wittbrodt, 46. In addition to the custodial sentence, United States District Judge Laurie J. Michelson also ordered that Wittbrodt be placed on a two-year term of supervised release. In addition, Wittbrodt was ordered to pay $7,317,173.51 in restitution to Blue Cross Blue Shield of Michigan and $902,387.93 in restitution to Medicare. As part of his plea agreement, Wittbrodt also agreed to forfeit approximately $72,000 seized by federal agents.
According to court documents, Wittbrodt and his co-defendants caused an approximate $8,000,000 loss to Medicare and Blue Cross Blue Shield of Michigan (“BCBS”). Some of this money was stolen from UAW members’ prescription insurance accounts.
Court documents outlined the scheme:
Due to the high reimbursement rate paid by Medicare and BCBS for prescription pain cream, scar cream, pain patches and/or vitamins, defendants targeted these insurance plans. Wittbrodt and others would then schedule time at various UAW meetings where defendants would tout pain cream, scar cream, pain patches and vitamins to the UAW members. An aspect of the presentation was that the UAW members could receive their prescriptions free -- without paying a prescription drug copay at the pharmacy. UAW members did not realize that acceptance of the “free” medications would cost their health care fund millions of dollars.
Defendants would then collect the UAW members’ insurance information along with their family members’ insurance information. According to court documents, Dr. April Tyler, who also pleaded guilty in the case, would then authorize the pain cream, scar cream, pain patch and/or vitamin prescriptions for the UAW members and/or their family members. Defendant Dr. Tyler did not establish a valid doctor-patient relationship with any of the UAW members, did not perform a physical exam and did not determine medical necessity for the prescriptions she wrote for the UAW members. The prescriptions were not, therefore, legally eligible for reimbursement from the various insurance companies. Defendant Dr. Tyler also pre-signed prescription forms and allowed defendants to choose which compounded creams, patches and vitamins to write on the prescriptions.
Wittbrodt directed the prescriptions to various pharmacies. The pharmacies would fill the prescriptions, bill the UAW members’ insurance and pay a monetary kickback to Wittbrodt. Wittbrodt would then provide remuneration to co-conspirators from the kickbacks he received. The prescriptions were periodically re-filled and/or re-billed, regardless of whether the UAW member requested a refill or not. The prescription co-pay was waived at the pharmacy for the UAW members. Another defendant, Jeffrey Fillmore, is scheduled for sentencing on November 23, 2021.
“The unlawful actions of these defendants diverted taxpayer dollars and medications from patients who actually needed them in order to line their own pockets,” said Acting United States Attorney Saima Mohsin. “We will continue to aggressively prosecute health care fraud and hold those who commit it accountable.”
“Medical professionals who try to enrich themselves by billing federal health care programs for medically unnecessary prescription medications threaten the integrity of these programs and waste valuable taxpayer dollars that are otherwise utilized to provide medications that patients genuinely need,” said 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. “Our agency, working together with our law enforcement partners, will continue to pursue criminals who threaten these vital health care programs.”
“Schemes that solicit and provide unneeded prescription drugs to patients erodes the confidence that U.S. consumers have in their health care professionals and others in positions of trust,” said Special Agent in Charge Lynda M. Burdelik, FDA Office of Criminal Investigations Chicago Field Office. “Medical professionals and others should know that the FDA will investigate and bring to justice those involved in the illegal distribution of prescription drugs.”
“This case demonstrates that collaboration between law enforcement and private insurance investigators is essential in prosecuting those responsible for federal healthcare fraud and kickback violations,” said by Dan Crowell, Blue Cross Blue Shield of Michigan, Director of Corporate and Financial Investigations.
This case was investigated by the United States Department of Health and Human Services – Office of Inspector General, the United States Food and Drug Administration and Blue Cross Blue Shield of Michigan, under the supervision of the U.S. Attorney’s Office for the Eastern District of Michigan. Assistant U.S. Attorney Philip A. Ross and Wayne Pratt are prosecuting the case.