A Tampa, Florida, man has been convicted by a federal grand jury on 22 counts of mail fraud, conspiracy to commit health care fraud, and introduction of a misbranded drug into interstate commerce after his months-long trial ended in early December.
Peter Bolos, 44, was accused along with his co-conspirators of defrauding pharmacy benefits managers (PBMs) after getting them to process and approve tens of thousands of prescription claims on behalf of both private and government insurance companies. By having these prescription claims processed, Bolos and his co-conspirators, including companies that were owned by them, would receive payment from the PBMs for those claims. Officials explain that the scheme began at the end of May 2015 and lasted through April 1, 2018. Officials detail that the pharmacy fraud scheme generated $174 million in fraudulent claims. Bolos was responsible for roughly $89 million.
According to court documents presented at the trial, Bolos and other individuals and companies including Andre Assad, Michael Palso, Maikel Bolos, Larry Smith, Scott Roix, HealthRight LLC, Mihir Taneja, Arun Kapoor, and Sterling Knight Pharmaceuticals conspired together to defraud the PBMs out of millions of dollars. PBMs that were named include CVS Caremark and Express Scripts.
The court documents also highlight activities that brought forward the introduction of a misbranded drug into interstate commerce charge. According to officials, Bolos, along with Assad and Palso, owned Synergy Pharmacy located in Palm Harbor, Florida. Under the company, the trio purchased prescriptions from Scott Riox, a Florida telemarketer who operated under the name “HealthRight LLC.” Bolo and his conspirators paid out $500 for each prescription they purchased from Roix. During the course of the scheme, Bolos paid Roix over $30 million for no fewer than 60,000 prescriptions.
The Department of Justice explains that “Bolos and Roix disguised these prescriptions’ purchases with bogus marketing agreements. To obtain these prescriptions, Roix used HealthRight’s telemedicine platform to deceive patients into providing HealthRight with their insurance information.”
Evidence in court details that Roix would call consumers and convince them to agree to the prescriptions. The Department of Justice adds that once consumers agreed to the prescriptions, doctors who trusted HealthRight to screen consumers would then write out those prescriptions. Doctors who were pulled into the scheme had never met the patients, spoken to them, or even knew them according to the Justice Department.
Many of the prescriptions were generated for drugs including scar and pain creams as well as vitamins. Evidence brought at trial details that Bolos and his co-conspirators would select these specific drugs because they had a high profit value. Once the drugs were dispensed to the consumers, Bolos would then submit the false claims to private insurance groups like Blue Cross Blue Shield Tennessee, Medicare, and Tricare.
Special Agent in Charge Joseph E. Carrico of the FBI’s Knoxville Field Office shared, “Healthcare fraud is an egregious crime problem that impacts every American. The guilty verdict was a result of a multi-agency investigation into a complex health care fraud scheme that required substantial investigative resources. Along with its law enforcement partners, the FBI remains committed to investigate these crimes and prosecute all those that are intent in defrauding the American public."
Bolos is set to be sentenced on May 19, 2022.
