The Department of Justice (DOJ) office of public affairs has announced that on October 24, 2024, Alexandra Gehrke pleaded guilty to conspiracy to commit health care fraud and wire fraud. Gehrke is scheduled to be sentenced on Feb. 11 and faces a maximum penalty of 20 years in prison. Her husband Jeffrey King pleaded guilty on Jan. 31 to conspiracy to commit health care fraud and wire fraud, and faces a maximum penalty of 20 years in prison. According to the DOJ announcement, “Gehrke ran Apex Medical LLC and Viking Medical Consultants LLC, that contracted with medically untrained ‘sales representatives’ to locate elderly patients, including hospice patients, who had wounds at any stage and order amniotic wound grafts from a specific graft distributor.” Together they submitted $1,212,005,778 in false and fraudulent claims to health insurance plans which included over $960 million claims to federal health care programs. The press release states that Gehrke and King agreed to pay restitution in the amounts of $614,990,420 and $605,690,110, respectively, and forfeit over $410 million in funds that they obtained from the fraud. This is in addition the nearly $100 million in assets that the government has seized.
The DOJ determined that Gehrke received over $279 million in illegal kickbacks from the distributor of the grafts in exchange for the orders, and in turn paid the sales representatives tens of millions of dollars in unlawful kickbacks. Gehrke then referred the patients to a company co-owned by King, whose company contracted with nurse practitioners, directing them to, “…suspend their own medical judgment and apply all grafts ordered by the sales representatives, even when medically unreasonable and unnecessary, which resulted in the application of grafts to infected wounds, wounds that had already healed, and wounds that were not responding to the grafts.”
The case was handled through the Health Care Fraud Strike Force Program, which currently operates in nine Strike Forces across the country. The Health Care Fraud Unit is a leader in using advanced data analytics and algorithmic methods to identify newly emerging health care fraud schemes. The Strike Force Model centers on a cross-agency collaborative approach, bringing together the investigative and analytical resources of the Fraud Section, Federal Bureau of Investigation, U.S. Department of Health and Human Services-Office of the Inspector General, Centers for Medicare & Medicaid Services, Drug Enforcement Administration, Defense Criminal Investigative Service, Federal Deposit Insurance Corporation-Office of the Inspector General, Internal Revenue Service-Criminal Investigations, Department of Labor-Office of the Inspector General, United States Postal Service-Office of the Inspector General, Veterans Administration-Office of the Inspector General, and other agencies.
Points of Contact to Report Health Care Fraud:
Health and Human Services Office of Inspector General (“HHS-OIG”):
- Make an online complaint HERE
- Call the tip hotline at 800-HHS-TIPS
Federal Bureau of Investigation (“FBI”), White-Collar Crime: The FBI is the primary agency for investigating health care fraud, for both federal and private insurance programs.
- Make an online complaint HERE
- Call the tip hotline at 800-CALL-FBI
Related posts:
- Wound care and skin substitutes: Rising costs, new policies and a whiff of scandal – ClearHealthCosts
- The Results Are In! How Much Can a Sales Rep Make per Month in Commissions by Selling High-Priced Amniotic Tissues (So They Say…)? – Caroline Fife M.D.
- According to Medicare Data Analyzed by SmartTRAK, Recent DOJ Prosecutions in the Cellular Tissue Product / Skin Substitute Market are the “Tip of the Iceberg” – Caroline Fife M.D.
- SAHS Billing Activity, the MSSP, and WTF – Caroline Fife M.D.
- The Accountable Care Organizations are Watching… – Caroline Fife M.D.
- Help! Can Someone Explain if Accepting Discounts Below the Cellular Tissue Product / Skin Substitute Average Sales Price (ASP) is Legal? – Caroline Fife M.D.
- Selling the Spread on Cellular Tissue Products (CTP’s) / Skin Substitutes – is That Even Legal? – Caroline Fife M.D.
- Billion Dollar Medicare Scam? Politico Article Discusses Dramatic Spike in Claims for “Skin Substitutes” – Caroline Fife M.D.
- Wound Care Company Owners Arrested, Accused of Accepting More Than $330M in Kickbacks Relating to Medicare Charges for Amniotic Products – Caroline Fife M.D.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
