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Court: United States District Court for the Eastern District of Texas (Jefferson County)
Plaintiff's Attorney: United States District Attorney’s Office
Description: Beaumont, TX - The United States of America charged Grigoriy T. Rodonaia with health care fraud.
According to the indictment, beginning in January 2015, Rodonaia is alleged to have participated in a health care fraud scheme by issuing prescriptions for specially compounded scar creams using the names, dates of birth, and Health Insurance Claim Numbers of TRICARE beneficiaries and caused the prescriptions to be forwarded directly to Memorial Compounding Pharmacy in Houston, Texas without the specific knowledge of the beneficiary and without having examined or consulted with the beneficiary. The prescriptions were billed to the military health care program, TRICARE, by the pharmacy at the approximate cost of $9,000 - $13,000 per prescription and the prescriptions authorized multiple refills. Over 600 prescriptions in the names of approximately 140 beneficiaries were issued by Rodonaia in this manner outside the usual course of professional practice and without medical necessity. Before the scheme could be detected, TRICARE paid approximately $6.7 million in TRICARE funds to Memorial Compounding Pharmacy. The indictment also alleges Rodonaia created patient files and records of the TRICARE beneficiaries as though he had examined or consulted with those patients and submitted those false records to the Defense Health Agency as part of an audit of the prescription scheme.
The indictment also alleges the defendant violated the Anti-kickback statute by requiring Medicare and Medicaid beneficiaries seeking opioid treatment to pay cash for an office visit in excess of the amount which would have been reimbursed by the Medicare and Medicaid programs. The indictment further alleges that Rodonaia dispensed a Schedule IV controlled substance, Adipex-P or Phentermine, a weight control drug, outside the course of standard medical practice.
If convicted, Rodonaia faces up to 10 years in prison for each count of health care fraud and a mandatory 2 years in prison for each count of aggravated identity theft. A grand jury indictment is not evidence of guilt.
This case is being investigated by the Defense Criminal Investigative Service, the Drug Enforcement Administration, Health and Human Services – Office of Inspector General, and the Texas Medicaid Fraud Control Unit. Assistant U.S. Attorney Robert L. Rawls is prosecuting this case.
Outcome: The charges set forth in the Indictment are merely accusations and do not constitute proof of guilt. Every defendant is presumed to be innocent unless and until proven guilty.