Financial Crime Weekly: Hospice Provider Fined $26.3M For False Covid Claims, Trio Sent To Jail For Selling $88M In Pirated Business Telephone Software

Provista Health, a Dallas-based hospice provider, has been ordered to pay $26.3 million for billing Medicare for a variety of medically unnecessary respiratory pathogen panel (RPP) tests that were given to nursing homes during the pandemic, the Department of Justice announced on Thursday.

On July 18, the U.S. District Court for the District of Maryland entered default judgments totaling the aforementioned amount against Provista and other laboratory companies owned by Patrick Britton-Harr for violating the False Claims Act.

In a July 2023 complaint, the U.S. alleged that the RPP tests were not medically necessary because the beneficiaries had no symptoms of a respiratory illness and because the tests were for uncommon respiratory pathogens.

The complaint also alleged that Britton-Harr and Provista submitted claims for RPP tests that were never ordered by physicians and sometimes for RPP tests that were never performed, including over 300 claims for nasal swab test samples that were supposedly collected from beneficiaries who had already died.

Three Individuals Sentenced To Jail For Selling Pirated Business Telephone Software

A married couple and a third individual have been sentenced to jail for selling tens of thousands of pirated business telephone system software licenses with a retail value of over $88 million, the DOJ said.

Raymond Bradley "Brad" Pearce, 48, of Tuttle, Oklahoma, a computer system administrator, was sentenced on Thursday to four years in prison and ordered to pay $4 million. In June, Dusti O. Pearce, 46, his wife who also lives in Tuttle, was sentenced to one year and a day in prison and was ordered to pay $4 million.

Jason M. Hines, 44, of Caldwell, New Jersey, received an 18-month prison sentence and another 18 months of home confinement and was ordered to pay $2 million.

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The trio, who pleaded guilty to conspiracy to commit wire fraud in 2023, will also pay restitution as follows: $17 million for Brad Pearce, $10 million for Dusti Pearce and more than $5 million for Hines.

The Pearces conspired with Hines to commit wire fraud in a scheme that involved making and selling unauthorized Avaya Direct International (ADI) software licenses used to unlock functionalities of the IP Office telephone system.

Avaya Holdings Corporation, a California-based international business communications company that sold IP Office, also sold software licenses that unlocked IP Office’s functions.

Brad Pearce, a customer service employee at Avaya, used his system administrator privileges to generate tens of thousands of ADI software license keys that he illegally sold to Hines and other customers, who in turn sold them to resellers and end users worldwide.

He also hijacked the accounts of former Avaya employees to make more license keys, concealing the overall scheme by changing information on the accounts, while Dusti Pearce served as the illegal operation’s accountant.

Doctor Faces Years In Prison For Illegally Distributing Controlled Substances, Defrauding Health Care Benefit Programs

A federal jury convicted a Louisiana physician yesterday for conspiring to illegally distribute over 1.8 million doses of Schedule II controlled substances, including oxycodone and morphine, and for defrauding health care benefit programs of more than $5.4 million, the DOJ said on Tuesday.

According to court documents, Adrian Dexter Talbot, 58, owned and operated Medex Clinical Consultants in Slidell, Louisiana, that accepted cash payments for controlled substances.

Talbot ignored signs that individuals frequenting Medex were drug-seeking or abusing the drugs prescribed.

In 2015, he left pre-signed prescriptions for opioids and other controlled substances at his clinic so that individuals who never saw him could acquire the drugs while he was working a full-time job in Pineville.

In 2016, he hired another practitioner who also pre-signed prescriptions to be distributed in the same manner at the Slidell clinic in exchange for cash deposited into the Medex account.

Talbot falsified patient records to cover up the scheme, in which individuals used insurance benefits to fill prescriptions. This resulted in fraudulent billing to health care benefit programs because prescriptions were written without a proper patient examination or determination of medical necessity.

He faces up to 10 years in prison for conspiracy to commit health care fraud and 20 years in prison for the other counts.

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