Bolton pharmacist pleads guilty to multimillion-dollar healthcare fraud scheme
A Bolton pharmacist pleaded guilty on Tuesday after his role in a multimillion-dollar scheme to defraud private insurance companies, as well as TRICARE.
David “Justin” Rutland, 42, accomplished this by referring medically unnecessary compounded prescription medications which he dispensed within his pharmacies that he co-owns. He admitted to his role in this scheme that caused more than $180 million fraudulent charges — $50 million of which was paid by federal healthcare programs.
In addition to this admission of guilt, Rutland admitted to adjusting prescription formulas to ensure the highest reimbursement without regard to efficacy; soliciting recruiters to procure prescriptions for high-margin compounded medications and paying those recruiters commissions based on the percentage of reimbursements paid by pharmacy benefit managers and health care benefit programs, including commissions on claims reimbursed by TRICARE; and routinely and systematically waiving and/or reducing copayments to be paid by beneficiaries and members, including utilizing a purported copayment assistance program to falsely make it appear as if Rutland’s pharmacy and its affiliate compounding pharmacies had been collecting copayments.
His plea of guilty to conspiracy to defraud the United States and solicit, receive, offer and pay illegal kickbacks could result in up to five years in prison. His sentencing trial is set to take place on Nov. 30. Additionally, Rutland must pay restitution and give up any assets that can be traced to money received as a result of the scheme.
The FBI and the General Defense Criminal Investigative Service are investigating the case.
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