US attorneys – eastern district of TN earn national investigation award

Published 7:25 pm Wednesday, November 30, 2022

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The United States Attorney’s Office – Eastern District of Tennessee has earned an award for its substantial work in bringing to justice those who committed healthcare fraud on unsuspecting victims.

Members of the Knoxville-based office staff along with participating federal partners received a national commendation for their work in ‘Operation Health Wrong’ – a long-term, multi-defendant program that prosecuted those suspected of healthcare fraud.

The National Health Care Anti-Fraud Association chose Operation Health Wrong for the award during its annual training conference. This year, the Association shined the spotlight on the U.S. Attorney’s Office for its successful investigation and prosecutions of multiple defendants.

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Operation Health Wrong, consisting of an investigation of a telemarketing and pharmacy scheme, resulted in the indictment of seven individuals including a medical doctor and two pharmacists and the related organizations they controlled. All but one of the individuals entered guilty pleas to offenses related to the investigation. A jury found the remaining defendant, Peter Bolos, guilty of conspiracy to commit healthcare fraud, mail fraud and criminal misbranding following a month-long trial last year in the United States District Court in Greeneville, Tennessee.

Bolos and his co-conspirators Michael Palso, Andrew Assad, Scott Roix, Larry Smith, Mihir Taneja, Arun Kapoor and Maikel Bolos, as well as various companies owned or controlled by some of these individuals, deceived pharmacy benefit managers (PBMs), such as Express Scripts and CVS Caremark, regarding tens of thousands of prescriptions. 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 such as Blue Cross Blue Shield of Tennessee, and public insurers such as Medicaid and TRICARE, paid to pharmacies controlled by the co-conspirators.

In May 2022, the Honorable J. Ronnie Greer imposed sentences in the case that ranged from 14 years in federal prison to probation. The Court also ordered over $100 million in restitution and forfeiture. The United States recovered over $26 million at or prior to the completion of sentencing.

The National Health Care Anti-Fraud Association recognized the following members of the United States Attorney’s Office for the Eastern District of Tennessee for their work on the case:

former Assistant United States Attorney T.J. Harker, Assistant United States Attorney Mac D. Heavener, Legal Assistants Barbra Pemberton and April Denard, and IT Specialist Brian Brandenburg.

Federal partners receiving recognition include the Department of Justice Consumer Protection Branch (former Assistant Director John Claud and Trial Attorney David Gunn), the United States Department of Health and Hunan Services, Office of Inspector General (Supervisory Special Agent Robert Turner), the United States Department of Homeland Security, Homeland Security Investigations (Special Agent John Lyons), the Federal Bureau of Investigation (Special Agent Reanna O’Hare and Financial Analyst LeAnn Lanz), the United States Food and Drug Administration, the Office of Criminal Investigations (Special Agent Brian Kriplean), the United States Office of Personnel Management, Office of Inspector General (Supervisory Special Agent Wayne VanVarick), and the United States Postal Service, Office of Inspector General (Special Agent Timothy Jones).

The Association’s mission is to protect and serve the public interest by increasing awareness and improving the detection, investigation and the civil and criminal prosecution and prevention of healthcare fraud and abuse.