Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 1 of 15
`
`FILED
`
` 2021 Apr-28 AM 10:26
`U.S. DISTRICT COURT
`N.D. OF ALABAMA
`
`PFE/LCP/DBL
`GJ # 12 (May 2021)
`
`
`
`IN THE UNITED STATES DISTRICT COURT FOR THE
`NORTHERN DISTRICT OF ALABAMA
`JASPER DIVISION
`
`
`UNITED STATES OF AMERICA
`
`v.
`
`PHILLIP ANTHONY MINGA
`
`
`
`CASE NO. _____
`
`)
`)
`)
`)
`18 U.S.C. §§ 2, 1343, 1347,
`)
`) and 1349
`
`
`
`
`INDICTMENT
`
`The Grand Jury charges that:
`
`
`
`At all times relevant to this Indictment:
`
`I.
`
`INTRODUCTION
`
`The Medicare Program and Medicare Part D
`The Medicare Program (“Medicare”) is a federal health-insurance
`1.
`
`program that provides medical benefits, items, and services to beneficiaries: (1) aged
`
`65 and older, (2) under 65 with certain disabilities, and (3) of all ages with end-stage
`
`renal disease (permanent kidney failure requiring dialysis or a kidney transplant).
`
`2.
`
`The Centers for Medicare and Medicaid Services (“CMS”) is an agency
`
`of the U.S. Department of Health and Human Services and is a federal government
`
`body responsible for the administration of Medicare.
`
`
`
`1
`
`
`
`FILED
`
` 2021 Apr-28 AM 10:26
`U.S. DISTRICT COURT
`N.D. OF ALABAMA
`
`PFE/LCP/DBL
`GJ # 12 (May 2021)
`
`
`
`IN THE UNITED STATES DISTRICT COURT FOR THE
`NORTHERN DISTRICT OF ALABAMA
`JASPER DIVISION
`
`
`UNITED STATES OF AMERICA
`
`v.
`
`PHILLIP ANTHONY MINGA
`
`
`
`CASE NO. _____
`
`)
`)
`)
`)
`18 U.S.C. §§ 2, 1343, 1347,
`)
`) and 1349
`
`
`
`
`INDICTMENT
`
`The Grand Jury charges that:
`
`
`
`At all times relevant to this Indictment:
`
`I.
`
`INTRODUCTION
`
`The Medicare Program and Medicare Part D
`The Medicare Program (“Medicare”) is a federal health-insurance
`1.
`
`program that provides medical benefits, items, and services to beneficiaries: (1) aged
`
`65 and older, (2) under 65 with certain disabilities, and (3) of all ages with end-stage
`
`renal disease (permanent kidney failure requiring dialysis or a kidney transplant).
`
`2.
`
`The Centers for Medicare and Medicaid Services (“CMS”) is an agency
`
`of the U.S. Department of Health and Human Services and is a federal government
`
`body responsible for the administration of Medicare.
`
`
`
`1
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 2 of 15
`
`3.
`
`The Medicare programs cover different types of benefits that are
`
`separated into different program parts.
`
`4. Medicare Part D, also called the Medicare prescription drug benefit, is
`
`a program that covers prescription drugs. Medicare beneficiaries obtain Part D
`
`benefits in two ways: (a) by joining a prescription drug plan, which covers only
`
`prescription drugs, or (b) by joining a Medicare Advantage Plan, which covered both
`
`prescription drugs and medical services (collectively, “the Medicare Plans”). The
`
`Medicare Plans are operated by private companies, often referred to as drug plan
`
`sponsors, that are approved by Medicare.
`
`5. Medicare and individual Medicare drug plan sponsors are “health care
`
`benefit programs,” as defined by Title 18, United States Code, Section 24(b).
`
`6.
`
`A pharmacy can participate in the Medicare Part D program by entering
`
`into an agreement: (a) directly with a prescription drug plan; (b) with one or more
`
`Pharmacy Benefit Managers (“PBMs”); or (c) with a Pharmacy Services
`
`Administration Organization (“PSAO”). A PBM acts on behalf of one or more
`
`prescription drug plans. Through a prescription drug plan’s PBM, a pharmacy can
`
`join a prescription drug plan’s network. A PSAO contracts with PBMs on behalf of
`
`the pharmacy.
`
`7.
`
`CMS assigns pharmacies a national provider identifier number (“NPI”).
`
`
`
`2
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 3 of 15
`
`A pharmacy dispensing medications to a beneficiary uses its assigned NPI number
`
`when submitting a claim for reimbursement under Medicare Part D.
`
`8.
`
`Typically, a beneficiary enrolled in a Medicare prescription drug plan
`
`obtains prescription medications from a pharmacy enrolled in the beneficiary’s
`
`prescription drug plan. After filling a beneficiary’s prescription, the pharmacy
`
`submits the claim electronically either directly to a prescription drug plan or to a
`
`PBM that represents the prescription drug plan. The pharmacy provides, among
`
`other things, the beneficiary’s identification number and the pharmacy’s NPI
`
`number with the claim. Then, the prescription drug plan or PBM, either directly or
`
`indirectly, reimburses the pharmacy for the claim.
`
`II. Exclusion from Medicare
`
`9.
`
`The Department of Health and Human Services, Office of Inspector
`
`General (HHS OIG) has the authority to exclude medical providers and related
`
`individuals from Medicare if they fail to disclose required material information.
`
`10. Once excluded, an individual may not serve in an executive or
`
`leadership role at a provider that furnishes items or services payable by Medicare.
`
`Also, an excluded individual may generally not provide other types of administrative
`
`and management services, such as information technology services and support,
`
`strategic planning, billing and accounting, staff training, and human resources.
`
`
`
`3
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 4 of 15
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`11. HHS OIG maintains a List of Excluded Individuals/Entities that
`
`identifies all currently excluded individuals and entities. HHS OIG recommends
`
`that healthcare entities routinely check the List of Excluded Individuals/Entities to
`
`ensure that new hires and current employees are not on it because employers risk
`
`liability for employing excluded individuals. Access to this list is free and available
`
`online.
`
`III. Defendant MINGA
`
`12. Defendant PHILLIP ANTHONY MINGA is a resident of Mississippi
`
`and has operated pharmacies in Alabama, Mississippi, and Arkansas.
`
`A. Defendant MINGA’s Prior Criminal Conviction
`
`13. On May 27, 2008, defendant MINGA was charged in federal district
`
`court in the Northern District of Mississippi with wire fraud related to the sale of
`
`insurance, in Case Number: 08-cr-00052-MPM-DAS.
`
`14. On April 5, 2010, defendant MINGA entered a guilty plea to the charge
`
`of wire fraud.
`
`15. On November 18, 2010, defendant MINGA was sentenced by the court
`
`to three years’ probation.
`
`B. Defendant MINGA’s Exclusion from Medicare
`
`16. At the time defendant MINGA was charged, he had managing control
`
`
`
`4
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 5 of 15
`
`of a durable medical equipment supplier called Medpoint. Medpoint, at that time,
`
`was operating in Amory, Mississippi and was enrolled in Medicare.
`
`17. After defendant MINGA pled guilty and was sentenced, neither he nor
`
`anyone else with Medpoint updated Medpoint’s Medicare enrollment information to
`
`notify CMS of defendant MINGA’s conviction, which they were required to do.
`
`18. Following an investigation by HHS OIG, on October 17, 2016,
`
`defendant MINGA entered into an Exclusion Agreement with HHS OIG in which
`
`defendant MINGA agreed to an exclusion from Medicare for ten years.
`
`19. The exclusion agreement provided that Medicare would not pay claims
`
`submitted by anyone who employed defendant MINGA in a management or
`
`administrative role.
`
`20. The exclusion agreement further provided that defendant MINGA
`
`would hold Medicare harmless for any financial responsibility for claims submitted
`
`by any entity that employed him in a management or administrative role.
`
`21. The exclusion agreement
`
`further stated defendant MINGA
`
`“understands that violations of the conditions of exclusion may subject him to
`
`criminal prosecution.”
`
`22.
`
`In executing
`
`the exclusion agreement, defendant MINGA
`
`acknowledged having knowledge of its contents and that he entered into it
`
`
`
`5
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 6 of 15
`
`voluntarily and with advice of counsel.
`
`Count One
`[Conspiracy: 18 U.S.C. § 1349 (18 U.S.C. § 1343 and 1347)]
`
`23. Paragraphs 1 to 22 of this Indictment are fully incorporated as though
`
`set forth herein.
`
`THE CONSPIRACY
`
`24. Beginning at least in or about October 2016 and continuing until at least
`
`in or about September 2019, the exact dates being unknown, within Walker County
`
`in the Northern District of Alabama, and elsewhere, defendant PHILLIP
`
`ANTHONY MINGA knowingly and willfully conspired, combined, and agreed
`
`with those known and unknown to the Grand Jury:
`
`to execute and attempt to execute a scheme and artifice to defraud
`a)
`health care benefit programs affecting commerce, as defined in Title 18,
`United States Code, Section 24(b), that is, the Medicare program and
`Medicare drug plan sponsors, to obtain by means of materially false and
`fraudulent pretenses, representations, and promises, money and property
`owned by, and under the custody and control of, said health care benefit
`programs, in connection with the delivery and payment for health care
`benefits, items, and services in violation of Title 18, United States Code,
`Section 1347; and
`
`to devise and intend to devise a scheme and artifice to defraud the
`b)
`Medicare program and Medicare drug plan sponsors, and others, and to obtain
`money and property belonging to others by means of materially false and
`fraudulent pretenses, representations, and promises by use of interstate wire
`transmissions, in violation of Title 18, United States Code, Section 1343.
`
`
`OBJECT OF THE CONSPIRACY
`6
`
`
`
`
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 7 of 15
`
`25.
`
`It was the object of the conspiracy for defendant PHILLIP
`
`ANTHONY MINGA and other co-conspirators known and unknown to the grand
`
`jury to unlawfully enrich themselves by concealing from Medicare and Medicare
`
`drug plan sponsors defendant MINGA’s ownership interests and managerial roles
`
`in multiple pharmacies and by submitting claims to Medicare and Medicare drug
`
`plan sponsors for reimbursement to which those pharmacies were not entitled due to
`
`defendant MINGA’s involvement with the pharmacies.
`
`MANNER AND MEANS OF THE CONSPIRACY
`
`26.
`
`It was a part of the conspiracy that defendant MINGA, once excluded
`
`from Medicare, continued to bill Medicare and Medicare drug plan sponsors by
`
`submitting and causing the submission of claims under NPI numbers registered to
`
`multiple pharmacies that defendant MINGA had an ownership and managerial
`
`interest in, including Bowie’s Priority Care Pharmacy, LLC, Vickers Pharmacy, and
`
`others.
`
`27.
`
`It was a further part of the conspiracy that defendant MINGA and other
`
`co-conspirators failed to disclose to Medicare, Medicare drug plan sponsors, and
`
`other regulatory authorities that defendant MINGA had ownership interests and
`
`managerial roles in these pharmacies.
`
`
`
`7
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 8 of 15
`
`28.
`
`It was a further part of the conspiracy that the defendant MINGA and
`
`other co-conspirators used electronic claims systems to submit claims to Medicare
`
`and Medicare drug plan sponsors by interstate wire transmission.
`
`29.
`
`It was a further part of the conspiracy that in violation of his exclusion
`
`agreement, from October 2016 to September 2019, defendant MINGA caused
`
`Medicare and Medicare drug plan sponsors to pay millions of dollars in total to
`
`multiple pharmacies, including Bowie’s Priority Care Pharmacy, LLC and Vickers
`
`Pharmacy, for items, including administrative and managerial services, that
`
`defendant MINGA furnished or ordered while serving as owner, employee,
`
`administrator, and in other capacities at these pharmacies.
`
`All in violation of Title 18, United States Code, Section 1349.
`
`Counts 2 through 5
`[Health Care Fraud: 18 U.S.C. § 1347]
`
`30. Paragraphs 1 to 22 of this Indictment are fully incorporated as though
`
`set forth herein.
`
`31. Beginning at least in or about October 2016 and continuing until at least
`
`in or about September 2019, the exact dates being unknown, within Walker County
`
`in the Northern District of Alabama, and elsewhere, defendant PHILLIP
`
`ANTHONY MINGA did knowingly and willfully execute and attempt to execute a
`
`scheme and artifice to defraud health care benefit programs affecting commerce, as
`8
`
`
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 9 of 15
`
`defined in Title 18, United States Code, Section 24(b), that is, Medicare and
`
`Medicare drug plan sponsors, and others, and to obtain, by means of materially false
`
`and fraudulent pretenses, representations, and promises, money and property owned
`
`by and under the custody and control of these and other health care benefit programs,
`
`in connection with the delivery of and payment for health care benefits, items, and
`
`services.
`
`PURPOSE OF THE SCHEME AND ARTIFICE
`
`32. Paragraph 25 of this Indictment is realleged and incorporated by
`
`reference as though fully set forth herein as the description of the purpose of the
`
`health care fraud scheme and artifice.
`
`THE SCHEME AND ARTIFICE
`
`33. Paragraphs 26 to 29 of this Indictment are hereby incorporated by
`
`reference as though fully set forth herein, with the words “scheme and artifice”
`
`replacing “conspiracy” in the first sentence of each paragraph.
`
`ACTS IN EXECUTION OF THE SCHEME AND ARTIFICE
`
`34. On or about the dates set forth below for each Count listed in the table
`
`below, each such date constituting a separate count of this Indictment, in Walker
`
`County, within the Northern District of Alabama, and elsewhere, defendant
`
`PHILLIP ANTHONY MINGA, in connection with the delivery of and payment
`
`
`
`9
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 10 of 15
`
`for health care benefits, items, and services, did knowingly and willfully execute and
`
`attempt to execute the above-described scheme and artifice to defraud health care
`
`benefit programs affecting commerce, that is, Medicare and Medicare drug plan
`
`sponsors, and to obtain, by means of materially false and fraudulent pretenses,
`
`representations, and promises (including that the prescriptions were medically
`
`necessary), money and property owned by, and under the custody and control of,
`
`Medicare and Medicare drug plan sponsors.
`
`35. The allegations of paragraphs 31 to 34 above are realleged for each of
`
`Counts 2 through 5 below, as though fully set forth therein, when, on or about the
`
`dates set forth below in the table below, defendant PHILLIP ANTHONY MINGA
`
`did cause the submission of prescription payment claims through certain pharmacies
`
`that Minga managed or controlled to Medicare and Medicare drug plan sponsors,
`
`and cause the payment of these prescription claims by Medicare and Medicare drug
`
`plan sponsors (with the Medicare drug plan sponsor listed in a parenthetical) of the
`
`following:
`
`Count
`
`RX #
`
`Patient
`Initials
`
`Healthcare Benefit
`Program
`
`2
`
`3
`
`4
`
`
`
`6090016
`
`6106146
`
`R.F.
`
`R.F.
`
`6137846
`
`H.A.
`
`Medicare
`(Excellus Health Plan)
`Medicare
`(Excellus Health Plan)
`Medicare
`(CareSource)
`10
`
`Approx.
`Date
`Submitted
`February
`17, 2017
`April 20,
`2017
`August 28,
`2017
`
`Pharmacy
`
`Vickers
`Pharmacy
`Vickers
`Pharmacy
`Vickers
`Pharmacy
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 11 of 15
`
`Count
`
`RX #
`
`Patient
`Initials
`
`Healthcare Benefit
`Program
`
`5
`
`760031173 M.T.
`
`Medicare
`(Care Improvement Plus)
`
`Approx.
`Date
`Submitted
`January 24,
`2018
`
`Pharmacy
`
`Bowie’s
`Priority Care
`Pharmacy, LLC
`
`
`All in violation of Title 18, United States Code, Sections 1347 and 2.
`
`Counts 6 through 8
`[Wire Fraud: 18 U.S.C. § 1343]
`
`36. Paragraphs 1 to 22 of the Introduction to this Indictment are fully
`
`incorporated as though set forth herein.
`
`37. Beginning at least in or about October 2016 and continuing until at least
`
`in or about September 2019, the exact dates being unknown, within Walker County
`
`in the Northern District of Alabama, and elsewhere, defendant PHILLIP
`
`ANTHONY MINGA, having devised and intending to devise a scheme and artifice
`
`to defraud, and for obtaining money and property by means of false and fraudulent
`
`pretenses, representations, and promises, knowingly did transmit and cause to be
`
`transmitted by means of wire, radio, and television communication in interstate and
`
`foreign commerce, writings, signs, signals, pictures, and sounds, for the purposes of
`
`executing such scheme and artifice, that is, defendant PHILLIP ANTHONY
`
`MINGA caused to be transmitted by means of wire prescription claims to Medicare
`
`and Medicare drug plan sponsors.
`
`
`
`11
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 12 of 15
`
`PURPOSE OF THE SCHEME AND ARTIFICE
`
`38. Paragraph 25 of this Indictment is realleged and incorporated by
`
`reference as though fully set forth herein as the description of the purpose of the mail
`
`fraud scheme and artifice.
`
`THE SCHEME AND ARTIFICE
`
`39. Paragraphs 26 to 29 of this Indictment are hereby incorporated by
`
`reference as though fully set forth herein, with the words “scheme and artifice”
`
`replacing “conspiracy” in the first sentence of each paragraph.
`
`THE WIRES
`
`40. The allegations of paragraphs 37 to 39 of this Indictment are realleged
`
`as though fully set forth herein.
`
`41. On or about the dates specified in the table below, each such date
`
`constituting a separate count of the Indictment, in Walker County, within the
`
`Northern District of Alabama, and elsewhere, for the purpose of executing and
`
`attempting to execute the above-described scheme and artifice to defraud and to
`
`obtain money by means of materially false and fraudulent pretenses, representations,
`
`and promises, defendant PHILLIP ANTHONY MINGA knowingly transmitted or
`
`caused to be transmitted by means of wire, in interstate commerce, writings, signs,
`
`and signals for the purpose of executing the above scheme or artifice:
`
`
`
`12
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 13 of 15
`
`Count
`
`RX #
`
`Patient
`Initials
`
`Healthcare Benefit
`Program
`
`6143018
`
`J.S.
`
`Medicare
`(UnitedHealthcare)
`
`Approx.
`Date
`Submitted
`June 6,
`2017
`
`6
`
`7
`
`8
`
`
`
`
`
`Pharmacy
`
`Bowie’s Priority
`Care Pharmacy,
`LLC
`Bowie’s Priority
`Care Pharmacy,
`LLC
`Bowie’s Priority
`Care Pharmacy,
`LLC
`
`760032109 W.H. Medicare
`(UnitedHealthcare)
`
`February
`22, 2018
`
`760032109 W.H. Medicare
`(UnitedHealthcare)
`
`May 1,
`2018
`
`
`All in violation of Title 18, United States Code, Sections 1343 and 2.
`
`
`
`13
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 14 of 15
`
`NOTICE OF FORFEITURE
`
`The allegations in Count One through Eight of this Indictment are
`
`1.
`
`hereby re-alleged and incorporated by reference for the purpose of alleging forfeiture
`
`pursuant to Title 18, United States Code, Section 982(a)(7).
`
`2.
`
`Upon conviction of the offenses set forth in Counts One through Eight
`
`of this Indictment, the defendant
`
`PHILLIP ANTHONY MINGA,
`
`shall forfeit to the United States of America, pursuant to Title 18, United States
`
`Code, Section 982(a)(7), any property, real or personal, that constitutes or is derived,
`
`directly or indirectly, from gross proceeds traceable to the commission of the health
`
`care fraud offenses charged in Counts One through Eight of this Indictment.
`
`3.
`
`The property to be forfeited includes but is not limited to a forfeiture
`
`money judgment.
`
`4.
`
`If any of the property described above, as a result of any act or omission
`
`of the defendant:
`
`a. cannot be located upon the exercise of due diligence;
`
`b. has been transferred or sold to, or deposited with, a third party;
`
`c. has been placed beyond the jurisdiction of the court;
`
`d. has been substantially diminished in value; or
`
`
`
`14
`
`
`
`Case 6:21-cr-00103-LSC-JHE Document 1 Filed 04/27/21 Page 15 of 15
`
`e. has been commingled with other property which cannot be
`
`divided without difficulty,
`
`the United States of America shall be entitled to forfeiture of substitute property
`
`pursuant to Title 21, United States Code, Section 853(p), as incorporated by Title
`
`28, United States Code, Section 2461(c).
`
`
`
`All pursuant to 18 U.S.C. § 982(a)(7).
`
`A TRUE BILL
`
`
`/s/ Electronic Signature
`FOREPERSON OF THE GRAND JURY
`
`
`PRIM F. ESCALONA
`United States Attorney
`
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`/s/ Electronic Signature
`LLOYD C. PEEPLES, III
`Assistant United States Attorney
`
`/s/ Electronic Signature
`DON B. LONG
`Assistant United States Attorney
`
`15
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