Thursday, April 19, 2018

Ex-NFL Player Sentenced In Health Care Fraud


Miami Herald (FL)
April 16, 2018 Health/Employee Benefits

April 16--Monty Grow was raised in the sleepy town of Inverness, went to college up the road at the University of Florida and starred on an SEC championship football team.
After a few years in the NFL, Grow would carve out a second career in sales and attain the good life on Tampa Bay.
But his mistake -- a colossal one -- was setting up a marketing company to recruit and refer members of the U.S. military and their families to a South Florida pharmacy. Prosecutors say it fraudulently billed the federal government tens of millions of dollars for unnecessary medical creams to treat scars and pain.
On Monday, Grow, 46, was sentenced to 22 years in prison by a federal judge with a long history of harshly punishing offenders of U.S. government healthcare programs. Grow, whose lawyers were seeking one-third that time, chose not to comment when U.S. District Judge Federico Moreno asked him if he wanted to say anything before sentencing on his healthcare fraud conviction in Miami.
Grow's defense team plans to appeal Moreno's sentencing.
While hammering Grow, the judge reminded the former football star of the place where he committed his scheme to bilk about $20 million from the TRICARE program for U.S. military members, veterans and their families. "In the Southern District of Florida, we're No. 1 in fraud," Moreno said, pointing out that the defendant showed no remorse for his crime.
In February, a Miami federal jury convicted Grow not only of a healthcare-fraud conspiracy but also of conspiring to receive and pay kickbacks to his sales team for referring hundreds of military beneficiaries to the Pompano Beach-based pharmacy, Patient Care America. He was also found guilty of money laundering. But Grow was also acquitted of numerous other related charges.
The jury had to decide whether Grow intentionally defrauded the government program or was simply paid lavish but legitimate sales commissions by the pharmacy for referring the TRICARE patients through his independent marketing company.
Grow's lawyers, Jeff Marcus and Daniel Rashbaum, urged the judge to be reasonable in his sentencing, noting that eight other defendants in the case -- including former University of Florida star and retired NFL quarterback Shane Matthews -- received punishment ranging from probation to less than two years. In the conspiracy to fleece the TRICARE program, Matthews, 47, was sentenced to three months in prison for his bit role on Grow's marketing team, lining up sales representatives who then landed TRICARE patients for the pharmacy.
"This is money made from a sales commission, not stolen from a bank," Marcus told the judge, urging him to be "proportional" in his punishment of Grow, who received about $20 million from the Pompano Beach pharmacy for patient referrals.
Prosecutor Kevin Larsen urged Moreno to be tough on Grow. "He knew the difference between right and wrong, good and bad," Larsen said. "The fact is, he had everything going for him. He had a great career in the NFL ... but he got greedy."
Grow and his network of sales representatives referred about 700 patients to Patient Care America, which received $40 million from the government program for supplying costly pain and scar creams along with wellness vitamins between 2014 and 2015. For those referrals, PCA paid half of those federal reimbursements to Grow under a contract agreement. With his cut of the taxpayer funds, Grow kept $10 million for himself and paid out the rest in kickbacks to his marketing associates who recruited TRICARE patients. The sales representatives acted as independent contractors, akin to Avon or Mary Kay reps.
Eventually, Grow himself went from being an independent contractor to a full-time employee for Patient Care America, which factored into his acquittals on numerous kickback charges.
At trial, prosecutors said many of the military members who were referred by his marketing network to Patient Care America did not need the costly compounds, which are specially mixed medications unlike typical commercial drugs. Many only agreed to buy the compound medications because Grow and his sales team paid kickbacks to the patients, who also referred other family members to the pharmacy.
Prosecutors said Grow's team covered patients' expensive co-payments for the creams and vitamins. One sales representative even paid her stable of patients $1,000 each for filling out a customer survey after receiving their medications from the pharmacy.
The 2016 indictment accusing Grow of conspiracy, fraud, kickbacks and money laundering did not charge Patient Care America or any of its top executives -- though prosecutors described them at trial as "unindicted co-conspirators." The Justice Department has joined a whistle-blower lawsuit filed against Patient Care and and a few of its senior officers.
Throughout the trial, prosecutors portrayed Grow as a clever salesman driven by greed who knew he was breaking the law while he pocketed $13,500 for each of the patients that his marketing company referred to the Broward County pharmacy. He owned a Tampa waterfront home, a Range Rover and a Porsche 911 and has millions in an e-trade stock market account -- though all of those assets have been seized by the feds.
Grow's defense attorneys, Rashbaum and Marcus, depicted the former football player as a lawful, successful businessman whose NFL career as a cornerback was cut short by injury in 1996 after playing for the Kansas City Chiefs and Jacksonville Jaguars. They said he began a marketing career in the field of compound pharmacies and later broke out on his own with a Tampa company called MGTEN -- his initials and jersey number as a ballplayer.
The defense argued that Grow set up his network of sales representatives to handle hundreds of TRICARE patients and arrange for them to see doctors through "telemedicine" companies. Grow paid the physicians for legitimate consultations, and they approved the vast majority of prescriptions for the compound medications provided by Patient Care America. The defense also said Grow paid his independent contractors "commissions" -- not kickbacks -- for finding the TRICARE patients.
Grow stood trial alone because an associate with whom he shared millions in kickbacks for the patient referrals pleaded guilty in early January to a conspiracy to commit healthcare fraud. Ginger Lay, who received about $6 million from Grow for her patient referrals, was initially sentenced to about five years in prison but that was reduced to less than two years for her testimony against Grow.
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