Dr. April Tyler, 57, a Fenton area doctor, pleaded guilty to violating the anti-kickback statute on Nov. 6. Tyler’s conspirators, Patrick Wittbrodt, 44, of Grand Blanc and Jeffrey Fillmore, 31, of Clio, pleaded guilty to healthcare fraud on March 6 and Nov. 19, respectively.
Tyler’s office was at Fenton Creative Healthcare in Fenton Township.
The defendants’ complex fraud and kickback scheme involved UAW members and medically unnecessary compounded pain creams, scar creams, pain patches and/or vitamins. According to court documents, the defendants caused an approximate $8 million loss to Medicare and
Blue Cross Blue Shield of Michigan (BCBS). Some of this money was stolen from UAW members’ prescription insurance accounts.
Court documents laid out the defendants’ scheme:
Due to the high reimbursement rate paid by Medicare and BCBS for prescription pain cream, scar cream, pain patches and/or vitamins, defendants targeted these insurance plans. Fillmore had acquaintances and personal contacts at the UAW through his job and various family members. Fillmore, Wittbrodt and Tyler would then schedule time at various UAW meetings where defendants would tout pain cream, scar cream, pain patches and vitamins to the UAW members. An aspect of defendants’ presentation was that the UAW members could receive their prescriptions free — without paying a prescription drug co-pay at the pharmacy. UAW members did not realize that acceptance of the “free” medications would cost their health care fund millions of dollars.
Defendants would then collect the UAW members’ insurance information along with their family members’ insurance information. Tyler would then authorize the pain cream, scar cream, pain patch and/or vitamin prescriptions for the UAW members and/or their family members. Tyler did not establish a valid doctor-patient relationship with any of the UAW members, did not perform a physical exam and did not determine medical necessity for the prescriptions she wrote for the UAW members. The prescriptions were not, therefore, legally eligible for reimbursement from the various insurance companies. Tyler also pre-signed prescription forms and allowed Wittbrodt and Fillmore to choose which compounded creams, patches and vitamins to write on the prescriptions.
Wittbrodt directed the prescriptions to various pharmacies. The pharmacies would fill the prescriptions, bill the UAW members’ insurance and pay a monetary kickback to Wittbrodt, who would then provide remuneration to Tyler and Fillmore from the kickback he received.
The prescriptions were periodically re-filled and/or re-billed, regardless of whether the UAW member requested a refill or not. The prescription co-pay was waived at the pharmacy for the UAW members.
Also according to court records, each defendant has agreed to the following federal sentencing guidelines:
• Patrick Wittbrodt: 70-87 months in prison
• Dr. April Tyler: 18-24 months in prison
• Jeffrey Fillmore: 37-46 months in prison
“These unlawful prescriptions cost the UAW health care fund millions of dollars, and the end result was a rip-off of the hard working men and women of the union,” said United States Attorney Matthew Schneider in a news release. “We will continue to aggressively prosecute health care fraud and step in to protect UAW workers across Michigan.”
“We rely on medical professionals to uphold the integrity of the prescription drug programs by only prescribing medications that are medically indicated and necessary. Circumventing this process solely for personal, financial gain compromises the integrity of these systems and takes away valuable healthcare dollars from patients who truly need the medications. HHS-OIG will continue to work with our law enforcement partners to protect and deter fraud within federal health care programs,” said Lamont Pugh III, special agent-in-charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General.
“Medical professionals and others should know that we will investigate and bring to justice to those involved in illegal distribution of unneeded drugs,” said special-agent-in-charge William P. Conway, FDA Office of Criminal Investigations Chicago Field Office.
“This case demonstrates that collaboration between law enforcement and private insurance investigators is essential in prosecuting those responsible for federal healthcare fraud and kickback violations,” said Dan Crowell, Blue Cross Blue Shield of Michigan, director of corporate and financial investigations.
This case was investigated by the United States Department of Health and Human Services – Office of Inspector General, the United States Food and Drug Administration and Blue Cross Blue Shield of Michigan, under the supervision of the U.S. Attorney’s Office for the Eastern District of Michigan. Assistant U.S. Attorney Michael Heesters and Wayne Pratt are prosecuting the case.