Michael Scott Burton, Health Care Fraud, Florida 2018

PENSACOLA, FLORIDA – Michael Scott Burton, a 51-year-old from Decatur, Georgia, and three accomplices were arraigned in the Northern District of Florida on Tuesday, June 26, after a federal grand jury returned an indictment charging them with a massive healthcare heist.

According to the indictment, Burton, along with Marie Ann Smith, 54, of Auburn, Georgia; Bradley D. Pounds, 46, of Jacksonville, Florida; and Heather E. Pounds, 45, also of Jacksonville, are accused of conspiring to commit health care fraud and wire fraud. Burton faces an additional charge of conspiracy to commit money laundering and 10 counts of money laundering.

The scheme allegedly defrauded TRICARE and other private insurance companies of more than $8 million for compounded creams and pills that were not medically necessary. The victims of this scheme never saw the “prescribing” health care provider.

Burton’s accomplices would provide him with personal identifying information and insurance cards of insurance company beneficiaries, for whom the prescriptions could be issued. Burton would then email this information to Hodgson and Smith, a billing coordinator at the Atlanta doctor’s office. Hodgson and Smith would then cause prescriptions, purportedly signed by the Atlanta doctor and bearing the doctor’s DEA registration number, to be issued and faxed to a pharmacy in Pensacola.

The Pensacola pharmacy would manufacture compounded substances and ship them to the respective health care beneficiaries, causing TRICARE and other health care benefit programs to be billed for the prescriptions.

The trial is scheduled for August 6, 2018. If convicted, all defendants face a maximum of 10 years in prison for each count of health care fraud conspiracy and a maximum of 20 years in prison for each count of wire fraud conspiracy. If convicted, Burton faces a maximum of 10 years in prison for each count of money laundering and money laundering conspiracy.

The case is being investigated by the Defense Criminal Investigative Service; the Florida Department of Law Enforcement; the Florida Department of Financial Services, Bureau of Insurance Fraud; and the Federal Bureau of Investigation. The case is being prosecuted by Assistant United States Attorney Tiffany H. Eggers.

An indictment is merely an allegation by a grand jury that a defendant has committed a violation of federal criminal law and is not evidence of guilt. All defendants are presumed innocent and entitled to a fair trial, during which it will be the government’s burden to prove guilt beyond a reasonable doubt in a court of law.

Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III announced today the largest ever health care fraud enforcement action involving 601 defendants and $6 billion in losses.

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