Two Florida men were sentenced Tuesday in U.S. District Court in Greeneville for their roles in a multimillion-dollar health care fraud scheme, according to the U.S. Attorney’s Office.
Peter Bolos, 44, of Tampa, was convicted by a federal jury in December 2021 of conspiracy to commit health care fraud, 22 counts of mail fraud and introduction of a misbranded drug into interstate commerce.
Senior U.S. District Judge J. Ronnie Greer sentenced Bolos to 14 years in prison and ordered him to pay more than $25.6 million in restitution and $2.5 million in forfeiture.
Greer also sentenced Bolos’ co-defendant, Michael Palso, 48, of Tampa, to 33 months in prison and ordered him to pay more than $24.6 million in restitution.
Palso previously pleaded guilty to his role in the conspiracy, as did 14 other defendants in related cases. The remaining defendants are scheduled to be sentenced this week.
According to court documents and evidence presented at trial, Bolos, Palso and their co-conspirators, Andrew Assad, Scott Roix, Larry Smith, Mihir Taneja, Arun Kapoor and Maikel Bolos, as well as various other companies owned or controlled by some of these individuals, deceived pharmacy benefit managers, or PBMs, such as Express Scripts and CVS Caremark, “regarding tens of thousands of prescriptions,” a news release said.
The PBMs processed and approved claims for prescription drugs on behalf of insurance companies. Bolos and his co-conspirators defrauded the PBMs into authorizing millions of dollars’ worth of claims that private insurers including Blue Cross Blue Shield of Tennessee; and public insurers such as Medicaid and TRICARE, paid to pharmacies controlled by the co-conspirators.
“The significant sentences imposed by the court are a reflection of the gravity of the crimes that the defendants in this case committed. The department will continue to work with law enforcement partners to prosecute those who take advantage of telemedicine to perpetrate fraud schemes,” Deputy Assistant Attorney General Arun G. Rao, head of the Justice Department Civil Division’s Consumer Protection Branch, said in the release.
Francis M. Hamilton, U.S. Attorney for the Eastern District of Tennessee, said the “scale of the prescription-drug fraud scheme orchestrated by Bolos and his conspirators was astonishing, and the 14-year sentence reflects the seriousness of Bolos’s participation in that conspiracy.”
Joseph E. Carrico, special agent in charge of the FBI Knoxville field office, said the sentencings result from “a multi-agency investigation into a complex telemedicine pharmacy fraud scheme, requiring substantial investigative resources.”
Added Justin C. Fielder, special agent in charge of the U.S. Food and Drug Administration’s Office of Criminal Investigations: “Distributing misbranded prescription drugs in the U.S. marketplace places patients’ health at risk. We will continue to pursue and bring to justice those who put profits ahead of public health.”
Court documents and evidence at trial established that Bolos, Assad and Palso owned and operated Synergy Pharmacy in Palm Harbor, Florida. Under their direction, Synergy employed Scott Roix, a Florida telemarketer operating under the name HealthRight, to generate prescriptions for Synergy and the other pharmacies involved in the scheme.
The prescriptions were typically for drugs such as pain creams, scar creams and vitamins. To obtain the prescriptions, Roix used HealthRight’s telemarketing platform as a telemedicine service, cold-calling consumers and deceiving them into agreeing to accept the drugs and to provide their personal insurance information.
“HealthRight then paid doctors to authorize the prescriptions through its telemedicine platform, even though the doctors never communicated directly with the patients and relied solely on the telemarketers’ screening process as the basis for their authorizations,” the release said.
Because the fraudulent process made the prescriptions invalid, the drugs were misbranded under the federal Food, Drug and Cosmetic Act. Synergy and the other pharmacies “nonetheless dispensed the drugs to consumers as part of the scheme, so that Bolos could submit fraudulent reimbursement claims,” the release said.
The trial verdict and plea agreements resulted from a multi-year investigation.
Assistant U.S. Attorney Mac Heavener for the Eastern District of Tennessee and Senior Trial Attorney David Gunn of the Civil Division’s Consumer Protection Branch are prosecuting the case. They were assisted by Barbara Pemberton, Bryan Brandenburg and April Denard from the U.S. Attorney’s Office for the Eastern District of Tennessee.