Source: Federal Bureau of Investigation (FBI) State Crime News
GREENVILLE, S.C. — Jeffrey Brooks, 40, of Clarence Center, New York, was sentenced to more than seven years in federal prison after pleading guilty to one count of conspiracy to commit health care fraud. In addition to Brooks’ criminal conviction, last year, Brooks paid $850,000 in a civil settlement to resolve allegations that he provided kickbacks and caused false claims to be submitted in violation of the federal False Claims Act.
Evidence presented to the court showed that beginning in or around May 2019, Brooks operated at least eight durable medical equipment (DME) companies, which were located in Fort Pierce, Florida. Through these DME companies, Brooks was charged with conspiring to submit or cause to be submitted false and fraudulent claims to Medicare and CHAMPVA for braces that were not medically necessary, eligible for reimbursement, and/or obtained through the payment of kickbacks and bribes. Specifically, evidence presented showed that Brooks and his co-conspirators purchased Medicare beneficiaries’ personally identifying information (“PII”) and purported personal health information (“PHI”) from third party call centers in order to generate doctors’ orders for braces. The doctor’s orders were generated by paying illegal kickbacks and bribes to telemedicine companies to obtain a medical practitioner’s signature on the doctor’s orders, regardless of medical necessity.
During the conspiracy, Brooks also was the beneficial owner of a call center located in Greenville, South Carolina, that purchased personal identifiable information of Medicare patients. Brooks and his co-conspirators, including purported telemedicine companies, then generated signed doctors’ orders, which were used to submit false and fraudulent claims to Medicare and cause false and fraudulent claims to be submitted to CHAMPVA.
The evidence presented to the court showed that the DME companies controlled by Brooks caused Medicare to be billed over $29 million in false and fraudulent claims.
“As we put an end to Brooks’ fraudulent scheme, he faces both accountability and justice,” said Adair F. Boroughs, U.S. Attorney for the District of South Carolina. “We will continue to seek out those defrauding federal healthcare programs.”
“By facilitating kickbacks, this defendant knowingly enabled theft from Medicare, putting personal profit before legitimate patient care and ultimately costing taxpayers millions of dollars,” said Tamala E. Miles, Special Agent in Charge at the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG is committed to working with our law enforcement partners to ensure that those alleged of defrauding federal health care programs are held accountable.”
“The penalties in this case underscore the importance of maintaining the integrity of healthcare systems,” said Steve Jensen, Special Agent in Charge of the FBI Columbia Field Office. “We are committed to safeguarding the interests of healthcare beneficiaries and ensuring accountability for those who exploit healthcare programs.”
“Today, this defendant was held accountable for his role in a long-term fraud scheme in which he enriched himself at the expense our nation’s veterans and that behavior will not be tolerated,” said Special Agent in Charge Kim. R. Lampkins of the Department of Veterans Affairs Office of Inspector General’s Mid-Atlantic Field Office. “We thank the U.S. Attorney’s Office and our law enforcement partners for their efforts in this joint investigation.”
The civil settlement resolves a lawsuit originally brought by Ashley Westover and Jessica Tollison, under the qui tam or whistleblower provisions of the False Claims Act. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of the civil resolution, Westover and Tollison received approximately $144,500 of the settlement amount.
The criminal resolution of this case was the result of a coordinated effort by the Justice Department’s Criminal Division, Fraud Section and the United States Attorney’s Office for the District of South Carolina, with assistance from the HHS-OIG, Special Agent Ryan Schubert, FBI, and VA-OIG. The civil resolution of this case was the result of efforts by the United States Attorney’s Office for the District of South Carolina, with assistance from the HHS-OIG, FBI, and VA-OIG.
United States District Judge Herlong sentenced Brooks to 90 months of imprisonment, to be followed by a three-year term of court-ordered supervision. There is no parole in the federal system. The Court also ordered that Brooks pay $15,221,227.60 in restitution – $15,198,432.00. to Medicare and $22,795.58 to CHAMPVA.
The criminal case was handled by Trial Attorney Catherine Wagner of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Amy Bower for the District of South Carolina. Assistant United States Attorney Beth Warren handled the civil case for the District of South Carolina.
The lawsuit resolved by the civil settlement is captioned United States ex rel. Westover, et al., Civ. No. 6:21-cv-00417-TMC (D.S.C., filed February 9, 2021).
The government’s pursuit of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to HHS at 1-800-HHS-TIPS (800-447-8477).
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