Former NFL player convicted in nearly $200M Medicare fraud scheme

Former NFL tight end Joel Rufus French bilked Medicare out of nearly $200 million by selling patient information and sham doctors’ orders for orthotic braces that patients did not want or need.

A federal jury in the Middle District of Florida convicted French, the owner of a marketing company, for his role in a years-long scheme to defraud Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs.

“This defendant’s conduct was egregious: he targeted seniors suffering from Alzheimer’s and dementia and billed Medicare for orthotic braces for deceased patients and amputees,” said Assistant Attorney General A. Tysen Duva of the Justice Department’s Criminal Division. “These schemes undermine the integrity of our health care system by robbing taxpayer-funded programs meant for legitimate medical care. Today’s verdict sends a clear message: the Criminal Division will aggressively prosecute those who prey on our nation’s seniors and veterans to steal from Medicare.”

According to court documents and evidence presented at trial, French, 47, of Amory, Miss., worked with overseas call centers that pressured elderly Americans to provide their personal and health insurance information and agree to accept medically unnecessary orthotic braces.

French starred at TE for the Ole Miss Rebels in 1997-98. He was a two-time All-American, earning unanimous honors in 1998. He was also a member of the Seattle Seahawks and Green Bay Packers for a brief time in the NFL.

“This scheme built on sham operations exploited seniors and corrupted the federal health care system. By falsifying doctors’ orders and selling patient information, the defendant sought to turn Medicare into their own personal ATM machine,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG will stop and catch anyone who exploits vulnerable patients to bilk federal healthcare programs and hold them accountable to the full extent of the law.”

Some of the individuals who agreed to the braces suffered from Alzheimer’s and dementia. In certain instances, the call centers altered call recordings to make it seem like Medicare patients agreed to the braces when they did not.

“This guilty verdict holds the defendant accountable for his role in a healthcare fraud scheme that targeted a program meant for deserving veterans and their families,” said Special Agent in Charge David Spilker with the Department of Veterans Affairs Office of Inspector General Southeast Field Office. “The VA OIG will continue to work with our law enforcement partners to root out fraudsters and hold them responsible.”

French paid sham telemedicine companies to obtain signed orders from doctors and nurse practitioners who never examined, and often never even spoke to, the patients.

He sold the orders to marketers and medical supply companies, which then submitted claims to Medicare. French also defrauded Medicare and CHAMPVA, the health care program for spouses and children of veterans who have or had a permanent and total service-connected disability or who died from a service-connected condition, by billing the programs for orthotic braces through eight durable medical equipment supply companies that he owned and managed, using false documents to hide his connection to the companies from Medicare.

The evidence at trial showed that French and his co-conspirators caused Medicare to be billed for braces for amputees for limbs they did not have and for deceased beneficiaries. Also during the conspiracy, French withdrew approximately $225,000 in cash from a bank in Mississippi, over $10,000 of which was placed in a bag and driven to Orlando to pay accomplices who sold him beneficiaries’ personal and insurance information.

The jury convicted French of conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and conspiracy to offer, pay, solicit, and receive kickbacks. French faces a maximum penalty of 20 years in prison for conspiracy to commit health care fraud and wire fraud, 10 years in prison for conspiracy to commit money laundering, and five years in prison for conspiracy to defraud the United States.

A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. A sentencing date has not been set.

HHS-OIG, FBI, and VA-OIG investigated the case.

Acting Assistant Chief Catherine Wagner and Trial Attorney William Hochul III of the Justice Department’s Fraud Section prosecuted the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of eight strike forces operating in federal districts across the country, has charged more than 6,200 defendants who collectively billed federal health care programs and private insurers more than $45 billion.

This report compiled by InsuranceNewsNet staff.