The CEO of an Arizona software company has been convicted by a federal jury for his role in a criminal scheme to defraud the government and insurance companies of more than $1 billion.
The Department of Justice reported Tuesday that 79-year-old Gary Cox of Maricopa County, Arizona, was found guilty by a jury "for his role in operating a platform that generated false doctors' orders to defraud Medicare and other federal health care benefit programs."
DOJ investigators said the scheme involved people at several levels, but all working toward one goal: submit false medical claims and then grab the government and insurance company reimbursements.
Investigators said at the heart of the enterprise was a marketing network designed to draw in "hundreds of thousands of Medicare beneficiaries who provided their personally identifiable information." Then they were enticed, according to investigators, to "accept medically unnecessary orthotic braces, pain creams, and other items through misleading mailers, television advertisements, and calls from offshore call centers."
Cox, said investigators, took those fake orders to "pharmacies, durable medical equipment suppliers, and marketers with telemedicine companies that would accept illegal kickbacks and bribes in exchange for signed doctors' orders."
Those orders were then sent through the software company that Cox and his partners created, which "received payments for coordinating these illegal kickback transactions and referring the completed doctors' orders to the suppliers, pharmacies, and telemarketers that paid kickbacks and bribes for the orders."
Cox is facing up to 20 years in prison.
The DOJ said the case is part of a much larger criminal attempt to steal taxpayer dollars. Since 2007, a special investigative unit has charged more than 5,800 defendants who collectively have billed federal healthcare programs and private insurers more than $30 billion.
Jim Mishler ✉
Jim Mishler, a seasoned reporter, anchor and news director, has decades of experience covering crime, politics and environmental issues.
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