Participant in $6.5 Million Health Care Fraud Scheme Receives 96 Month Sentence and a Forfeiture of Over $1.4 Million

Michael Burton, of Decatur, Georgia, was sentenced to 96 months in federal prison for his participation in a scheme that defrauded TRICARE and other insurers a combined $6.5 million. According to the Department of Justice, Burton plead guilty to charges of conspiracy to commit health care fraud, conspiracy to commit money laundering, and money laundering.

From 2014 to 2015, Burton and his team of conspirators defrauded TRICARE and other private insurance companies through the submission of fraudulent claims for prescriptions including scar creams, pain creams, and wellness capsules. Sales representatives were recruited to obtain personal and insurance coverage information from individuals in exchange for commission payments. Co-defendant, Brad Hodgson, would then use the information to prescribe the compounded drugs without a necessary medical purpose. These individuals were not the patients of Hodgson, and he was not licensed to write prescriptions.

Once the prescriptions were forged, fraudulent claims for the reimbursement of these drugs were submitted to TRICARE and other insurers. These claims totaled $6.5 million, with Burton’s participation in the scheme profiting him a total of $1.4 million in the form of commission payments.

Other co-defendants included Bradley Pounds and Heather Pounds, who were recruited by Burton as sales representatives in the health care fraud scheme.

“Health care fraud is a crime that affects all Americans – but to perpetrate a scam that victimizes a program for our nation’s service members and their families is beyond appalling,” stated Lawrence Keefe, United States Attorney for the Northern District of Florida. “This conspiracy stole money meant to help those who have given so much to our nation, and the criminals behind it deserve the punishment they receive.”

For his participation in the defrauding of TRICARE and other insurers, Burton will serve 96 months in federal prison. He has also been ordered to pay over $6.5 million in restitution to TRICARE and will forfeit over $1.4 million.