Georgia’s ex-Insurance Commissioner John Oxendine has pleaded guilty to conspiring to commit healthcare fraud in federal court in Atlanta.
The fraud involved Dr Jeffrey Gallups and Texas lab Next Health, with whom Oxendine conspired to get orders for unnecessary medical tests, with kickbacks being paid as a result.
According to prosecutors, $260,000 in kickbacks were paid by the lab through Oxendine’s insurance consulting firm. The US Attorney’s Office for the Northern District of Georgia noted that Next Health paid the kickbacks to Oxendine and Gallups after filing insurance claims worth $2.5 million and being compensated nearly $700,000. As part of his guilty plea, Oxendine will have to return the money lost by insurers through the fraud.
“The Defendant agrees to pay $699,864.89 as restitution, jointly and severally with the defendant in case 1:21-CR-00370, plus applicable interest, to the Clerk of Court for distribution to the following victims of the offense(s) to which he is pleading guilty and all relevant conduct including, but not limited to, any counts dismissed as a result of this Plea Agreement,” reads part of the court document seen by Insurance Business.
The agreement lists the following victims: Aetna; BCBS of Georgia and BCBS Texas; Cigna, Cigna Healthcare PPO, and Cigna International; Corvel; Covenant Administrators; Coventry; Health Partners Claims; Humana; Meritain Health; PMA Insurance Group W/C; Qualcare, Inc.; UMR; and United Health Care and United Healthcare Student Resources.
In terms of imprisonment, the maximum term for Oxendine’s crime is a decade. The sentencing hearing, during which he might not be sentenced to the full 10 years in jail, is happening in July.
Commenting on the fraud, Keri Farley, Special Agent in Charge of FBI Atlanta, said: “This scheme to bill for unnecessary services has no place in our healthcare system. It not only increased healthcare costs for all beneficiaries, but they also violated the trust of patients. John Oxendine not only profited from this scheme but took it a step farther and directed another to lie to federal agents to try and cover up the fraud.”
US Attorney Ryan K. Buchanan, meanwhile, had this to say: “John Oxendine, as the former state-wide insurance commissioner, knew the importance of honest dealings between doctors and insurance companies. But for personal profit, he willfully conspired with a physician to order hundreds of unnecessary lab tests, costing hundreds of thousands of dollars. He will now be held accountable for violating the public’s trust.”
What do you think about this story? Share your thoughts in the comments below.
