U.S. Attorney for the Western District of Pennsylvania: Florida Man Sentenced to 10 Years in Prison and Ordered to Pay More Than $97M in Restitution for Participation in Multiple Health Care Fraud and Kickback Schemes

PITTSBURGH, Pennsylvania, May 7 -- The office of the U.S. Attorney for the Western District of Pennsylvania issued the following news release:

A resident of Fort Lauderdale, Florida, was sentenced in federal court to 120 months of imprisonment, to be followed by three years of supervised release, and was ordered to pay more than $97 million in restitution and to forfeit more than $30 million and the proceeds from the sale of a yacht for conspiring to commit health care fraud and conspiring to pay and receive unlawful kickbacks, First Assistant United States Attorney Troy Rivetti announced today.

United States District Judge W. Scott Hardy imposed the sentence on Daniel Hurt, 59.

According to information presented to the Court, Hurt engaged in three separate health care fraud and illegal kickback schemes.

First, he and his co-conspirators victimized both TRICARE--a program that provides civilian health care benefits for military personnel, military retirees, and military dependents--and CHAMPVA--a health care benefit program run by the Department of Veterans Affairs--through a scheme that involved the payment of illegal kickbacks. In all, that scheme caused a loss to TRICARE of more than $18 million and to CHAMPVA of more than $450,000. Hurt was initially indicted in the Southern District of Florida for his participation in that scheme, before his case was transferred to the Western District of Pennsylvania for sentencing.

Hurt admitted during his plea hearing that, through this scheme, he and his co-conspirators billed TRICARE, CHAMPVA, and other insurance providers for expensive compounded medications that were not medically necessary. Hurt and his co-conspirators worked with patient recruiters to solicit patients who had health insurance, with the patient recruiters then generating prescriptions containing the patients' information and a limited selection of expensive compounded medications. These prescriptions, which used formulations created or altered to obtain the maximum possible reimbursement from the insurance companies, were then referred to a telemedicine service and sent to a pharmacy owned by Hurt and his co-conspirators.

During the conspiracy, patient recruiters and the telemedicine service sent thousands of medically unnecessary prescriptions to this pharmacy, which, after filling the prescriptions, would bill patients' insurance plans thousands of dollars for the compounded medications. Once the pharmacy received payment for the prescriptions, the pharmacy would then pay a kickback to Hurt and his co-conspirators, who would, in turn, pay kickbacks to the patient recruiters. As part of his plea, Hurt admitted to personally receiving more than $4.2 million from this scheme.

Second, Hurt engaged in a scheme that involved the payment of illegal kickbacks related to cancer genomic (CGx) testing, which was billed as if the testing were done in the Western District of Pennsylvania. In all, Medicare suffered a loss of more than $25 million from that scheme. CGx testing uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future.

Hurt admitted that, beginning in late 2018 and continuing through approximately October 2019, he and his co-conspirators, including individuals associated with so-called marketing entities, acquired thousands of CGx testing samples from Medicare beneficiaries located throughout the United States. Marketers used targeted campaigns to induce beneficiaries to submit CGx specimens by means of cheek swabs sent to their homes or provided to them at purported "health fairs" held throughout the United States.

Hurt directed these CGx specimens to be sent to Ellwood City Medical Center (ECMC), a hospital located in Ellwood City, Pennsylvania. Hurt further used ECMC as the billing entity for Medicare purposes despite the fact that the facility did not possess properly validated equipment to conduct any CGx testing on-site and, as such, ECMC staff were required, at Hurt's direction, to repackage the samples and send them to third-party reference laboratories that were capable of completing the testing. In order to justify Medicare reimbursement for the CGx testing, Hurt and his co-conspirators obtained CGx prescriptions from telemedicine physicians without regard to the fact that the doctors did not conduct proper telemedicine visits, were not treating the Medicare beneficiaries for cancer or symptoms of cancer, and did not use the test results in the treatment of the beneficiaries.

During this time, Hurt directed ECMC staff to transfer millions of dollars from ECMC-related accounts to bank accounts that Hurt controlled. In turn, Hurt admitted using funds he obtained from ECMC to pay millions of dollars in kickbacks to the marketers, among others, in exchange for their efforts to obtain CGx samples. To disguise such kickbacks, Hurt entered into sham contracts with the marketers to make it appear that they were engaged in, and being paid for, legitimate marketing and referral services. Likewise, Hurt, acting through entities he controlled, entered into similar agreements and business arrangements with ECMC that disguised the payments he obtained from the facility as purportedly legitimate payments, including payments related to management services at ECMC's laboratory. Payments, in fact, were based on the volume of CGx tests and the amount of resulting Medicare reimbursements. Hurt also admitted that he and others used a portion of Medicare reimbursements obtained through the fraudulent submission of CGx claims to engage in monetary transactions in excess of $10,000, including approximately $3 million in payments toward the purchase of a luxury watercraft in Florida called "In My DNA."

Hurt's third scheme involved illegal kickback payments and cancer genomic testing that caused an additional loss to Medicare of at least $53.3 million. Hurt was initially charged for his participation in that scheme in the District of New Jersey, before his case was transferred to the Western District of Pennsylvania for sentencing.

In that scheme, Hurt admitted that he owned several clinical laboratories that conducted or arranged for a variety of medical tests, and that he paid kickbacks and bribes to various entities who supplied referrals and orders for CGx for Medicare and other health care benefit program beneficiaries, without regard to medical necessity. These laboratories submitted claims for payment to Medicare for these CGx tests, and Medicare reimbursed the laboratories without knowing that the services were not medically necessary or were procured through the payment of kickbacks. Hurt admitted paying kickbacks to entities who supplied referrals for each CGx test that was billed to Medicare and other health care benefit programs. To conceal the payments of bribes, Hurt and the suppliers entered into sham contracts to make it appear that the suppliers were engaged in, and being paid for, legitimate marketing and referral services. Hurt received at least $26.9 million from the $53.3 million reimbursed by Medicare.

First Assistant United States Attorney Rivetti commended the Federal Bureau of Investigation, Department of Health and Human Services - Office of Inspector General, Defense Criminal Investigative Service, United States Postal Inspection Service, Internal Revenue Service - Criminal Investigation, U.S. Department of Labor - Employee Benefits Security Administration, U.S. Department of Veterans Affairs - Office of Inspector General, Food and Drug Administration - Office of Criminal Investigation, and U.S. Army Criminal Investigation Division - Florida Fraud Resident Unit for the collaborative investigation leading to the successful prosecution of Hurt.

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Original text here: https://www.justice.gov/usao-wdpa/pr/florida-man-sentenced-10-years-prison-and-ordered-pay-more-97-million-restitution