A Michigan doctor and her two co-conspirators pleaded guilty for their involvement in an elaborate scheme that stole millions of dollars from the UAW health care fund.
The U.S. Attorney’s Office for the Eastern District of Michigan recently announced that Dr. April Tyler – whose offices are pictured above – pleaded guilty to violating anti-kickback statutes while Patrick Wittbrodt and Jeffrey Filmore both pleaded guilty to health care fraud.
Court documents in the case state that the three fraudsters caused an approximate $8 million loss to Medicare and Blue Cross Blue Shield of Michigan.
The documents describe their scheme in detail:
Due to the high reimbursement rate paid by Medicare and BCBS for prescription pain cream, scar cream, pain patches and/or vitamins defendants targeted these insurance plans. Defendant Fillmore had acquaintances and personal contacts at the UAW through his job and various family members. Defendants Fillmore, Wittbrodt and Tyler would then schedule time at various UAW meetings where defendants would tout pain cream, scar cream, pain patches and vitamins to the UAW members. An aspect of defendants’ presentation was that the UAW members could receive their prescriptions free — without paying a prescription drug copay at the pharmacy. UAW members did not realize that acceptance of the “free” medications would cost their health care fund millions of dollars.
Defendants would then collect the UAW members’ insurance information along with their family members’ insurance information. Defendant Dr. Tyler would then authorize the pain cream, scar cream, pain patch and/or vitamin prescriptions for the UAW members and/or their family members. Defendant Dr. Tyler did not establish a valid doctor-patient relationship with any of the UAW members, did not perform a physical exam and did not determine medical necessity for the prescriptions she wrote for the UAW members. The prescriptions were not, therefore, legally eligible for reimbursement from the various insurance companies. Defendant Dr. Tyler also pre-signed prescription forms and allowed defendants Wittbrodt and Fillmore to choose which compounded creams, patches and vitamins to write on the prescriptions.
Defendant Wittbrodt directed the prescriptions to various pharmacies. The pharmacies would fill the prescriptions, bill the UAW members’ insurance and pay a monetary kickback to Wittbrodt. Defendant Wittbrodt would then provide remuneration to defendants Dr. Tyler and Fillmore from the kickback he received. The prescriptions were periodically re-filled and/or re-billed, regardless of whether the UAW member requested a refill or not. The prescription co-pay was waived at the pharmacy for the UAW members.
Wittbrodt received the harshest sentence and will spend between 70 and 87 months in prison. Tyler faces 18-24 months in prison while Fillmore is looking at 37-46 months.
“These unlawful prescriptions cost the UAW health care fund millions of dollars, and the end result was a rip-off of the hard working men and women of the union,” said U.S. Attorney Matthew Schneider. “We will continue to aggressively prosecute health care fraud, and step in to protect UAW workers across Michigan.”
Lamont Pugh III, a special agent in charge for the Chicago region of the U.S. Department of Health and Human Services Office of Inspector General, said the medical system relies on “professionals to uphold the integrity of the prescription drug programs by only prescribing medications that are medically indicated and necessary.”
“Circumventing this process solely for personal, financial gain compromises the integrity of these systems and takes away valuable health care dollars from patients who truly need the medications. HHS-OIG will continue to work with our law enforcement partners to protect and deter fraud within federal health care programs,” he added.
The charges come amid an ongoing federal corruption investigation into the UAW that has taken out some of the union’s top leaders, including former UAW President Gary Jones, who resigned his union membership last week.
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Anthony Gockowski is managing editor of Battleground State News, The Ohio Star, and The Minnesota Sun. Follow Anthony on Twitter. Email tips to [email protected].
Photo “Offices of Dr. April Tyler” by April Tyler.