The scheme netted millions of dollars for Bolos, of Tampa, and other associates, according to a U.S. Department of Justice news release. Bolos will be sentenced on May 19, 2022, by Senior U.S. District Judge J. Ronnie Greer.
Court documents and evidence presented at trial show that Bolos, Andrew Assad, Michael Palso, Maikel Bolos, Larry Smith, Scott Roix, HealthRight LLC, Mihir Taneja, Arun Kapoor, and Sterling Knight Pharmaceuticals, in addition to companies owned by them, conspired to defraud pharmacy benefit managers, such as Express Scripts and CVS Caremark, out of millions of dollars, the release said.
Pharmacy benefit managers, or PBMs, pay pharmacies for prescription claims on behalf of public insurance programs such as Medicare and Tricare in addition to private insurance companies like Blue Cross Blue Shield of Tennessee.
Court documents and evidence at trial further proved that Bolos, Assad, and Palso, owners of Synergy Pharmacy in Palm Harbor, Florida, purchased prescriptions from Scott Roix for $500 apiece.
"Bolos and Roix disguised these prescriptions' purchases with bogus marketing agreements. To obtain these prescriptions, Roix used HealthRight's telemedicine platform to deceive patients into providing HealthRight with their insurance information," the release said.
Roix "then steered doctors to issue prescriptions through HealthRight's telemedicine platform by falsely telling the doctors the patients had requested the medications. In fact, the medications were selected by Bolos because they were highly profitable," evidence presented at trial shows.
The conspiracy lasted from May 26, 2015, through April 1, 2018. During that time, evidence showed that Bolos paid Roix more than $30 million to buy no fewer than 60,000 prescriptions.
"Nearly all these prescriptions were issued through HealthRight's telemedicine platform. The doctors who issued the prescriptions did not know, never met, and never spoke to the patients," the release said.
According to court documents, Roix, Assad, Palso, Smith, Maikel Bolos and various associated business entities previously pleaded guilty to their role in the conspiracy.
Taneja, Kapoor, and Sterling Knight pleaded guilty to felony misbranding in a conspiracy with Bolos. Sentencing for other defendants in the case will be set for dates in 2022.
The trial and plea agreements resulted from a multi-year investigation conducted by the U.S. Department of Health & Human Services Office of Inspector General in Nashville; Food and Drug Administration Office of Criminal Investigations in Nashville; the U.S. Postal Service, Office of Inspector General, in Buffalo, New York; FBI agents in Knoxville and Johnson City; the Office of Personnel Management Office of Inspector General in Atlanta; and the Department of Homeland Security, Homeland Security Investigations in Tampa. The U.S. Marshals Service also assisted in the investigation and the forfeiture of assets, the release said.
Assistant U.S. Attorneys TJ Harker and Mac Heavener, of the U.S. Attorney's Office for the Eastern District of Tennessee; and trial attorney David Gunn of the Consumer Protection Branch in Washington; prosecuted and tried the case for the government.