A Columbus couple have agreed to plead guilty to charges related to a health-care fraud scheme that involved compound creams prescribed to city employees and first responders.
Amy M. Kirk and Ryan D. Edney have agreed to plead guilty to one count of conspiring to commit health care fraud, a crime punishable by up to 10 years in prison, according to the Department of Justice.
Benjamin C. Glassman, United States Attorney for the Southern District of Ohio, Lamont Pugh III, Special Agent in Charge, United States Health and Human Services Office of Inspector General (HHS OIG), and Ohio Attorney General Dave Yost announced the case.
Kirk was a nurse practitioner at Pain Management Consortium of Ohio (PMCO). Her fiancé and co-defendant, Edney, was the president of RX Health Solutions, LLC, , according to court documents.
From 2014 until 2017, Kirk and Edney conspired to defraud Medicaid and other health insurers and enrich themselves by billing for compound cream medications that were not medically necessary.
Kirk also wrote prescriptions that were based on false medical conditions.
In some instances, prescriptions were written without ever meeting or examining the patient or were issued in exchange for kickback payments, according to the Department of Justice.
Kirk and Edney would recruit patients for compound pain creams, scar creams, migraine creams or wellness pills.
“It was part of the conspiracy that the defendants targeted city employees, including police officers, firefighters and teachers, because the government insurance programs were more inclined to pay for compound creams,” U.S. Attorney Glassman said. “Medications were typically prescribed with 11 refills to maximize reimbursement from the health care benefit programs and were shipped directly to patients.”
Kirk completed patient information sheets, often falsifying physical exam information and medical diagnoses. Kirk was then paid for each prescription she authored via kickbacks routed to Edney’s RX Health Solutions company, or directly to Edney himself.
The couple caused more than $751,000 in fraudulent insurance claims to Medicaid, Tricare and private insurance.
Tricare provides health care benefits to active duty service members, retired service members and their dependents.
Kirk and Edney personally received nearly $350,000 in kickbacks.
As part of their proposed pleas, Kirk and Edney would pay the $750,000 in restitution.
“Fake conditions, ‘wellness pills’ and examinations that never happened… this level of fraud would make a snake oil salesman blush,” Ohio Attorney General Yost said. “I am proud of our staff, and our partners in the U.S. Attorney’s Office for bringing these two to justice.”
The Court will consider the defendants’ offer of plea at a future plea hearing, which is yet to be scheduled.
U.S. Attorney Glassman commended the investigation of this case by HHS OIG and the Ohio Attorney General’s Medicaid Fraud Control Unit, as well as Assistant United States Attorneys Kenneth F. Affeldt and Maritsa A. Flaherty, who are representing the United States in this case.