Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 1 of 19 PAGEID #: 13
`
`2:20-cr-157
`
`Michael Watson
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 2 of 19 PAGEID #: 14
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 2 of 19 PAGEID #: 14
`
`including highly addictive opioids,
`
`through these facilities. As the owner and operator of
`
`Midwest, HENRYalso entered into agreements with Medicare and the Ohio Medicaid Program,
`
`among other insurance plans, to provide reimbursementfor certain services provided at Midwest.
`
`3.
`
`Defendant NICOLE GEORGES was employed as a
`
`representative of the
`
`pharmaceutical company Insys Therapeutics (“Insys”). GEORGES worked onsite at Midwest
`
`fromat least in or around 2014 throughat least in or around 2016.
`
`4.
`
`as
`
`Insys was incorporated in Delaware and headquartered in Chandler, Arizona.
`
`Individual
`
`1 was a licensed physician’s assistant who worked under JIMMY
`
`HENRY’s supervision at Midwest from approximately in or around November 2015 to in or
`
`around October 2019.
`
`The Controlled Substances Act and Code of Federal Regulations
`
`6.
`
`The Controlled Substances Act (“CSA”), Title 21, United States Code, Section
`
`841(a). ef seg., and Title 21, Code of Federal Regulations (“CFR”), Section 1306.04, governed
`
`the manufacture, distribution, and dispensation of controlled substances in the United States.
`
`The CSA and the CFR contained definitions relevant to this Indictment, as set forth below.
`
`Ts
`
`The term “controlled substance” meant a drug or other substance, or immediate
`
`precursor, included in Schedule I, Il, II. IV and V, as designated by Title 21, United States
`
`Code, Section 802(c)(6), and the CFR. The designation “Schedule II” meant the drug or other
`
`substance had a high potential for abuse; the drug had a currently accepted medical use with
`
`severe restrictions; and abuse of the drug or other substance may lead to severe
`
`psychological or physical dependence.
`
`8.
`
`Fentanyl, oxycodone, and tapentadol were opioids and Schedule II controlled
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 3 of 19 PAGEID #: 15
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 3 of 19 PAGEID #: 15
`
`substances. Fentanyl pharmaceutical products were available in multiple forms,
`
`including
`
`sublingual
`
`spray,
`
`transdermal patches,
`
`and injectable formulations. When fentanyl was
`
`prescribed for a legitimate medical purpose,it was typically for the management of breakthrough
`
`cancer pain in patients who were already receiving opioid medication for their underlying
`
`persistent pain. Transdermal patches were used in the management of chronic pain in patients
`
`who require continuous opioid analgesia. Fentanyl was a potent opioid medication and was
`
`sometimes abused for its intense euphoric effects.
`
`9.
`
`The term “dispense” meantto deliver a controlled substance to an ultimate user or
`
`research subject by, or pursuant to the lawful order of, a practitioner, including the prescribing
`
`and administering of a controlled substance. The term “distribute” meant to deliver (other than
`
`by administering or dispensing) a controlled substance.
`
`10.
`
`The Drug Enforcement Administration (“DEA”) issued registration numbers to
`
`qualifying doctors, who thereby became authorized to dispense Schedule II, III, IV, and V
`
`controlled substances. To issue a prescription for a controlled substance, a doctor was required
`
`to have a DEAregistration number for each location in which the doctor was dispensing
`
`medicine, and for each state where the doctor was prescribing controlled substances. The term
`
`“prescription” meant an order for medication which was dispensed to or for a user but did not
`
`include an orderfor medication which was dispensed for immediate administration to the user.
`
`11.
`
`Title 21, CFR, Section 1306.04, provided that “[a]ll prescriptions for controlled
`
`substances shall be dated as of, and signed on, the day whenissued and shall bear the full name
`
`and address ofthe patient. the drug name, strength, dosage form, quantity prescribed, directions
`
`for use, and the name, addressand registration numberofthe practitioner.”
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 4 of 19 PAGEID #: 16
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 4 of 19 PAGEID #: 16
`
`Ee.
`
`Under the CSA and CFR,a prescription for a controlled substance was unlawful
`
`unless issued for a legitimate medical purpose bya practitioner acting in the usual course of
`
`professional practice.
`
`The Medicare Program
`
`13.
`
`The Medicare program (“Medicare”) was a federal health care program, affecting
`
`commerce, that provided benefits to persons who were 65 years of age or older or disabled.
`
`14.|Medicare was administered by the United States Department of Health and
`
`Human Services, through its agency, the Centers for Medicare and Medicaid Services (“CMS”).
`
`Individuals who received benefits under Medicare were referred to as Medicare “beneficiaries.”
`
`15,
`
`Individuals who qualified for Medicare benefits were commonly referred to as
`
`“beneficiaries.” Each beneficiary was given a unique Medicare identification number.
`
`16.
`
`Medicare covered different types of benefits and was separated into different
`
`program “parts.”
`
`Li.
`
`Medicare Part B covered, among other things, physician services, outpatient care.
`
`and durable medical equipment.
`
`18.
`
`Medicare Part D subsidized the cost of prescription drugs
`
`for Medicare
`
`beneficiaries. Generally, Medicare Part D covered part or all of the costs of prescription drugs
`
`dispensed to a Medicare beneficiary if, among other requirements, the prescription drugs were
`
`medically necessary and ordered bya physician.
`
`19,
`
`In order to receive Medicare Part D benefits, a beneficiary enrolled in one of
`
`several Medicare drug plans. Medicare drug plans were operated by private health care
`
`insurance companies approved by Medicare. Those companies were often referred to as drug
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 5 of 19 PAGEID #: 17
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 5 of 19 PAGEID #: 17
`
`plan “sponsors,” each of which dictated the specific prescription drugs covered and how much
`
`would be paid for those drugs.
`
`20.
`
`Medicare,
`
`through CMS. compensated the Medicare drug plan sponsors for
`
`providing prescription drug benefits to beneficiaries. Medicare paid the sponsors a monthly fee
`
`for each Medicare beneficiary of the sponsors’ plans. Such payments were called capitation fees.
`
`Thecapitation fee was adjusted periodically based on various factors, including the beneficiary’s
`
`medical conditions.
`
`In addition, in some cases where a sponsor’s expenses for a beneficiary’s
`
`prescription drugs exceeded that beneficiary’s capitation fee, Medicare reimbursed the sponsor
`
`for a portion of those additional expenses.
`
`21.
`
`Medicare and Medicare drug plan sponsors were “health care benefit program|s],”
`
`as defined by Title 18, United States Code, Section 24(b), and “federal health care program|s].”
`
`as defined by Title 42, United States Code, Section 1320a-7b(f).
`
`22.
`
`As part of the Medicare enrollment process, health care providers,
`
`including
`
`physicians, submitted enrollment applications to Medicare.
`
`To participate in Medicare,
`
`including Medicare Part B and Part D, providers were required to certify that they would comply
`
`with all Medicare-related laws, rules, and regulations, including, among others, the federal Anti-
`
`Kickback Statute.
`
`If Medicare approved a provider's application, Medicare assigned the
`
`provider a Medicare provider number. A provider with a Medicare provider number could
`
`submit claims to Medicare to obtain reimbursement for medically necessary items and services
`
`rendered to beneficiaries. Medicare providers were given access to Medicare manuals and
`
`service bulletins describing procedures, rules, and regulations.
`
`ol
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 6 of 19 PAGEID #: 18
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 6 of 19 PAGEID #: 18
`
`The Ohio Medicaid Program
`
`23.
`
`Medicaid, established by Congress in 1965, was a federal and state funded health
`
`care program providing benefits to individuals and families who met specified financial and
`
`othereligibility requirements, and certain other individuals who lacked adequate resources to pay
`
`for medical care. CMS wasresponsible for overseeing the Medicaid programin participating
`
`states, including Ohio.
`
`Individuals who received benefits under Medicaid were referred to as
`
`Medicaid “beneficiaries.”
`
`24,
`
`Ohio Medicaid wasa “health care benefit program”as defined by Title 18, United
`
`States Code, Section 24(b), and a “federal health care program[s].” as defined by Title 42, United
`
`States Code, Section 1320a-7b(f).
`
`25.
`
`The Ohio Department of Medicaid (“ODM”) administered the Medicaid program
`
`in the State of Ohio. ODM received, reviewed, and paid Medicaid claims submitted by health
`
`care providers,
`
`including claims for professional services. such as office visits and medical
`
`procedures, as well as for prescription drug benefits.
`
`26,
`
`Pursuantto the rules and regulations issued by ODM. Medicaid covered the costs
`
`of certain medical services, products, and benefits,
`
`including prescription drug benefits, for
`
`Medicaid beneficiaries. Generally, Medicaid covered part or all of the costs ofprescription
`
`drugs dispensed to a Medicaid beneficiary if, among other requirements, the prescription drugs
`
`were medically necessary and ordered by a physician. As part of the process to become a
`
`Medicaid provider, health care practitioners were required to acknowledge that they understood
`
`and would abide by Medicaid’s rules, regulations, and program requirements.
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 7 of 19 PAGEID #: 19
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 7 of 19 PAGEID #: 19
`
`The Conspiracy to Unlawfully Distribute and Dispense Controlled Substances
`
`2d:
`
`From in or around September 2015 until at least around January 2019, JIMMY
`
`HENRY illegally distributed dangerous controlled substances to customers located in the
`
`Southern District of Ohio and elsewhere. HENRY unlawfully issued prescriptions for Schedule
`
`II controlled substances,
`
`including fentanyl, oxycodone, and tapentadol,
`
`to patients through
`
`Midwest, the practice he owned, at Midwest’s multiple offices. HENRY illegally issued these
`
`prescriptions himself, and with the assistance of Individual 1 and others known and unknownto
`
`the Grand Jury.
`
`The Health Care Fraud Conspiracy
`
`28.
`
`From in or around September 2015 until at least around January 2019, JIMMY
`
`HENRY,aided and abetted by Individual
`
`1 and others known and unknownto the Grand Jury,
`
`and conspiring therewith, caused false and fraudulent claims to be submitted for reimbursement
`
`to Medicare and the Ohio Medicaid Program for prescription medications that were not
`
`medically necessary, not eligible for reimbursement, induced by illegal kickbacks, and issued
`
`outside the usual course ofprofessional practice and without a legitimate medical purpose.
`
`29,
`
`It was the purpose of the conspiracy for HENRY and his co-conspirators to
`
`unlawfully enrich themselves by (1) submitting and causing the submission of false and
`
`fraudulent claims to Medicare and Ohio Medicaid for prescriptions for Subsys and other
`
`controlled substances which were induced bykickbacks, medically unnecessary, and noteligible
`
`for reimbursement; (2) concealing the submission of these false and fraudulent claims: and (3)
`
`diverting the fraud proceeds for their use and benefit and forthe use and benefit of others.
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 8 of 19 PAGEID #: 20
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 8 of 19 PAGEID #: 20
`
`Manner and Meansof the Health Care Fraud Conspiracy
`
`30.
`
`JIMMY HENRYfirst enrolled as a Medicare provider on or about September8,
`
`2010, and as such signed a provider agreement with CMSagreeing to abide bythe rules and
`
`regulations of the Medicare program. HENRYwasconsistently enrolled as a Medicare provider
`
`since that date and signed multiple updated provider agreements with CMS. Thesecertifications
`
`included acknowledgements by HENRYthat he would abide byall Medicare laws, regulations,
`
`and program instructions. These acknowledgementsincluded a specific agreement that HENRY
`
`would not violate the Federal Anti-Kickback Statute, that he would not knowingly present or
`
`cause to be presentedafalse or fraudulent claim for payment by Medicare, and that he would not
`
`submit claims with deliberate ignorance or reckless disregard oftheir truth orfalsity.
`
`Dias
`
`HENRY wasfirst enrolled as an Ohio Medicaid provider on or about September
`
`8, 2010, and as such, he also signed a provider agreement with ODM agreeing to abide by the
`
`rules and regulations of the program. HENRY was consistently enrolled as an Ohio Medicaid
`
`provider since that date and signed multiple updated provider agreements with ODM. These
`
`certifications included acknowledgements that HENRY would abide by the Medicaid Handbook,
`
`which specifically prohibited the submission of any claims for payment by Medicaid that were
`
`not medically necessary and the receipt of payment from any other person in connection with the
`
`provision of Medicaid services.
`
`32.
`
`As part of the conspiracy,
`
`JIMMY HENRY,
`
`Individual
`
`1, and their co-
`
`conspirators issued and caused to be issued prescriptions for controlled substances, including
`
`Subsys, a fentanyl-based sublingual spray,
`
`that were medically necessary,
`
`in that they were
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 9 of 19 PAGEID #: 21
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 9 of 19 PAGEID #: 21
`
`prescribed outside the usual course of professional practice and without a legitimate medical
`
`purpose, to patients who did not need these substances.
`
`33.
`
`As further part of the conspiracy, JIMMY HENRYand his co-conspirators at
`
`Midwest received payments from Subsys’ manufacturer,
`
`Insys Therapeutics,
`
`in return for
`
`purported speaking engagements that, in truth and in fact, never occurred. These engagements
`
`and payments, totaling approximately $60,900, coincided with HENRY’s increased prescribing
`
`of Subsys to patients in a manner that was medically unnecessary and was without a legitimate
`
`medical purpose.
`
`34,
`
`As further part of the conspiracy, JIMMY HENRY,Individual 1, and their co-
`
`conspirators submitted and caused the submissionoffalse and fraudulent claims to Medicare and
`
`Medicare drug plan sponsors, through Part D of the Medicare Program, and Ohio Medicaid for
`
`reimbursements for prescriptions for Subsys, which were medically unnecessary,
`
`induced by
`
`kickbacks, and ineligible for reimbursement.
`
`a5,
`
`Part D of
`
`the Medicare Program paid approximately $1,238,702.94 in
`
`reimbursement
`
`for Subsys prescriptions issued by HENRY,
`
`Individual
`
`1, and their co-
`
`conspirators. Ohio Medicaid paid approximately $454,756.84 in reimbursementforfilled Subsys
`
`prescriptions issued by HENRY,Individual 1, and their co-conspirators.
`
`The Kickback Scheme
`
`36.
`
`On or about January 4, 2012,
`
`the Food and Drug Administration (“FDA”)
`
`approved Insys’ application to market Subsys, a fentanyl-based sublingual spray,
`
`to patients
`
`suffering from breakthrough cancer pain. Breakthrough cancer pain was severe pain that erupted
`
`in patients with cancer who were already medicated with a long-acting painkiller. Due to its
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 10 of 19 PAGEID #: 22
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 10 of 19 PAGEID #: 22
`
`potency and the potential
`
`for addiction,
`
`the FDA approved use of Subsys solely for “the
`
`management of breakthrough pain in cancer patients 18 years of age and older whoare already
`
`receiving and whoare already tolerant to opioid therapy for their underlying persistent cancer
`
`pain.”
`
`af.
`
`The approximateretail cost of Subsys ranged from just under $2,000 per month
`
`for 30 doses of the Fentanyl Spray at 200mcg to over $8,000 per month for 30 doses of Subsysat
`
`the highest dosage of 1,600 meg. The cost of Subsys could have exceeded $16,000 per monthif
`
`multiple doses per day were prescribed.
`
`38.
`
`On or about October 10, 2014, defendant JIMMY HENRY entered into a
`
`purported “Speaker Agreement” with Insys. Pursuant to the agreement, HENRY would receive
`
`approximately $2,200 from Insys per speaking engagement.
`
`39.
`
`Many of the purported speaking programs conducted by defendant JIMMY
`
`HENRY, and for which he received payment from Insys, were sham programs. On many
`
`occasions HENRY did not attend the purported speaking program. On the occasions he did,
`
`HENRY discussed his own pain management practice and did not
`
`train any prescribers on
`
`Subsys as outlined in his Speakers Program contracts with Insys.
`
`40,
`
`During the years that defendant JIMMY HENRYparticipated in a Speaker
`
`Agreement, the number ofprescriptions that HENRY wrote for Subsys that were reimbursed
`
`through Medicare and Ohio Medicaid rose. As HENRY’s compensation from Insys increased in
`
`2014 and early 2015, so did his prescriptions of Subsys and the Medicare and Ohio Medicaid
`
`Program reimbursementtherefrom. After HENRY stopped receiving payments from Insys in or
`
`around October 2015, his prescribing of Subsys decreasedsignificantly.
`
`10
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 11 of 19 PAGEID #: 23
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 11 of 19 PAGEID #: 23
`
`41.
`
`GEORGES was the Insys representative assigned to HENRY. GEORGES
`
`facilitated the relationship between HENRY and Insys. GEORGES commonly worked out of
`
`Midwest and coordinated the alleged “speaking engagements” pursuant to HENRY’s “Speaker
`
`Agreement” contracts,
`
`including scheduling and often catering the events. GEORGES then
`
`attended the events and collected sign in sheets from the participants. GEORGESthen submitted
`
`documentation about the purported “speaking events”to Insys so that HENRY would be paid for
`
`these “speaking engagements” pursuantto his “Speaker Agreement” contracts.
`
`42.
`
`On multiple occasions including but not limited to on or about September 24,
`
`2015, defendant JIMMY HENRY, aided and abetted by others known to the Grand Jury,
`
`including NICOLE GEORGES, violated the Anti-Kickback Statute by agreeing to accept
`
`compensationpaid by Insys through the purported “Speaker Agreement” in return for increased
`
`prescribing of Subsys, a controlled substance which was marketed by Insys and GEORGES.
`
`COUNTS ONE THROUGH NINE
`
`UNLAWFULDISTRIBUTION AND DISPENSING OF CONTROLLED SUBSTANCES
`
`THE GRAND JURY CHARGES THAT:
`
`[21 U.S.C. § 841(a)(1)]
`
`43.
`
`Paragraphs 1 through 12 of the General Allegations Section of the Indictment are
`
`realleged and incorporated by reference as thoughfully set forth herein.
`
`44.
`
`On or about the dates set forth below,
`
`in the Southern District of Ohio, and
`
`elsewhere, the defendant JIMMY HENRY,aided and abetted by Individual 1 and others known
`
`and unknown to the Grand Jury, did knowingly,
`
`intentionally, and unlawfully dispense and
`
`distribute, and cause to be dispensed and distributed, outside the usual course of professional
`
`11
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 12 of 19 PAGEID #: 24
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 12 of 19 PAGEID #: 24
`
`practice and not for a legitimate medical purpose, the controlled substances listed below, each of
`
`which constitutes a separate count of this Indictment:
`
` La|bo|
` ST]ny)
`Als,
`1
`7/25/2016
`Fentanyl
`
`Controlled
`Substance(s
`Fentanyl
`Fentanyl
`Fentanyl
`Oxycodone
`
`Tapentado]
`Tapentadol
`Oxycodone
`Oxycodone
`
`
`
`
`
`
`
`
`
`
`
`Approximate Date of
`Count Patient
`Written Prescription
`
`10/13/2015
`C.B.
`M.M.
`10/14/2015
`M.M.
`2/2/2016
`
`LAO
`2/2/2016
`
`10/24/2016
`M.G.
`2/13/2017
`LB,
`o
`JF.
`2/14/2018
`ALL.
`1/30/2019
`Oo
`
`In violation of 21 U.S.C. §§ 841(a)(1), 841(b)(1)(C), and 18 U.S.C.§ 2.
`
`COUNT TEN
`
`CONSPIRACY TO UNLAWFULLY DISTRIBUTE CONTROLLED SUBSTANCES
`
`THE GRAND JURY FURTHER CHARGES THAT:
`
`[21 U.S.C. § 846]
`
`45.
`
`Paragraphs 1 through 12 of the General Allegations Section of the Indictment are
`
`realleged and incorporated by reference as though fully set forth herein.
`
`46.
`
`From on or about September 15, 2015 through on or about January 30, 2019, in
`
`the Southern District of Ohio, and elsewhere, the defendant JIMMY HENRY knowingly and
`
`intentionally combined, conspired, confederated, and agreed together with other persons known
`
`and unknown to the Grand Jury, including Individual 1, to unlawfully distribute and dispense
`
`controlled substances, including but not limited to fentanyl, oxycodone, and tapentadol.
`
`In violation of 21 U.S.C. § 846.
`
`12
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 13 of 19 PAGEID #: 25
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 13 of 19 PAGEID #: 25
`
`COUNT ELEVEN
`
`SOLICITING AND RECEIVING HEALTH CARE KICKBACKS
`
`[42 U.S.C. § 1320a-7b(b)(1)(B)]
`THE GRAND JURY FURTHER CHARGES THAT:
`
`47.
`
`Paragraphs | through 42 ofthe General Allegations Section of the Indictment are
`
`realleged and incorporated by reference as thoughfully set forth herein.
`
`AS,
`
`On or about
`
`the dates listed below,
`
`in the Southern District of Ohio and
`
`elsewhere, defendant JIMMY HENRY,aided and abetted by others known to the Grand Jury,
`
`including co-defendant NICOLE GEORGES, did knowingly and willfully solicit and receive the
`
`remuneration listed below,directly and indirectly, overtly and covertly, in cash and in kind, in
`
`return for purchasing,
`
`leasing, ordering, and arranging for and recommending purchasing,
`
`leasing, and ordering any good, facility, service, and item, that is, a significant increase in the
`
`number of Subsys prescriptions, for which payment may be made in whole and in part under
`
`Purported Speaking Program
`
`Federal health care programs, those are, Medicare and Ohio Medicaid:
`
`
`Approximate Date
`Payment
`Date and Location of
`Payment Received
`Amount
`
`
`
`32,200aatl Primary Care, Columbus, Ohio
`In violation of 42 U.S.C. § 1320a-7b(b)(1)(B) and 18 U.S.C.§ 2.
`
`9/11/2015, Arlington Mill Run — Central Ohio
`
`13
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 14 of 19 PAGEID #: 26
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 14 of 19 PAGEID #: 26
`
`COUNT TWELVE
`
`CONSPIRACY TO COMMIT HEALTH CARE FRAUD
`
`THE GRAND JURY FURTHER CHARGESTHAT:
`
`[18 U.S.C. § 1349]
`
`49,
`
`Paragraphs 1 through 42 of the General Allegations Section of the Indictmentare
`
`realleged and incorporated byreference as though fully set forth herein.
`
`50.
`
`From on or about September 15, 2015 until at least on or about January 30, 2019,
`
`in the Southern District of Ohio and elsewhere, the defendant JIMMY HENRYdid knowingly
`
`and willfully combine, conspire, confederate and agree with others known and unknown to the
`
`Grand Jury, including Individual 1, to knowingly and willfully execute a scheme andartifice to
`
`defraud health care benefit programs affecting commerce, as defined in Title 18, United States
`
`Code, Section 24(b), that is, Medicare and Ohio Medicaid, and to obtain, by means ofmaterially
`
`false and fraudulentpretenses, 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 of and payment for health care benefits, items, and services, in violation ofTitle 18,
`
`United States Code, Section 1347.
`
`Purpose of the Conspiracy
`
`51.
`
`Paragraph 29 of the General Allegations Section of this Indictmentis realleged
`
`and incorporated byreference as a description of the purpose ofthe conspiracy to commit health
`
`care fraud.
`
`14
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 15 of 19 PAGEID #: 27
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 15 of 19 PAGEID #: 27
`
`Manner and Means
`
`52.
`
`Paragraphs 30 through 35 of the General Allegations Section of this Indictmentis
`
`realleged and incorporated by reference as a description of the manner and means ofthe
`
`conspiracy to commit health care fraud.
`
`In violation of 18 U.S.C. § 1349.
`
`COUNTS THIRTEEN THROUGH FIFTEEN
`
`HEALTH CARE FRAUD
`
`[18 U.S.C. §§ 1347 and 2]
`THE GRAND JURY FURTHER CHARGESTHAT:
`
`a3
`
`Paragraphs | through 42 of the General Allegations Section of the Indictment are
`
`realleged and incorporated by reference as thoughfullyset forth herein.
`
`54.
`
`From on or about September 15, 2015 until at least on or about January 30, 2019,
`
`in the Southern District of Ohio and elsewhere,
`
`the defendant, JIMMY HENRY, aided and
`
`abetted by others and aiding and abetting others known and unknown to the Grand Jury,
`
`including Individual 1, participated in a schemeto defraud health care benefit programs affecting
`
`commerce, as defined in 18 U.S.C. § 24(b), namely Medicare and Ohio Medicaid, and to obtain,
`
`by meansofmaterially false and fraudulent pretenses, representations, and promises, money and
`
`property owned by, and underthe custody and control of, said health care benefit programs, in
`
`connection with the delivery of and payment for health care benefits, items, and services, which
`
`schemeis further described below.
`
`Purposeof the Scheme and Artifice
`
`55.
`
`It was the purpose of the scheme andartifice for HENRY andhis co-conspirators
`
`to unlawfully enrich themselves by (1) submitting and causing the submission of false and
`
`15
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 16 of 19 PAGEID #: 28
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 16 of 19 PAGEID #: 28
`
`fraudulent claims to Medicare and Ohio Medicaid for prescriptions for Subsys and other
`
`controlled substances which were induced through kickbacks, medically unnecessary, and not
`
`eligible for reimbursement; (2) concealing the submission ofthese false and fraudulent claims:
`
`and (3) diverting the fraud proceeds for their use and benefit and for the use and benefit of
`
`others.
`
`The Scheme and Artifice
`
`56.
`
`The Grand Jury realleges and incorporates by reference Paragraphs 30 through 35
`
`of this Indictment as a description of the schemeandartifice.
`
`Acts in Execution of the Scheme and Artifice
`
`af:
`
`On or about the dates specified below,
`
`in the Southern District of Ohio, and
`
`elsewhere, JIMMY HENRY,aided and abetted by others, and aiding and abetting others known
`
`and unknownto the Grand Jury, including Individual 1, did knowingly andwillfully execute, and
`
`attempt
`
`to execute,
`
`the above-described scheme and artifice to defraud health care benefit
`
`programsaffecting commerce, as defined in Title 18, United States Code, Section 24(b), that is,
`
`Medicare and Ohio Medicaid, 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, said health care benefit programs, as follows:
`
`. Sra|
`
`Euresnare
`Approximate
`
`Count|Beneficiary|Type of Claim Payer Source Date of Amount Paid
`
`
`Submitted Claim
`
`
`
`
`13 FESR|oa ettM.M 10/19/2015 $5,941.29
`
`(Subsys)
`
`Prescription
`(Subsys,
`Morphine)
`Prescription
`(Subsys)
`
`Medicare
`
`10/22/2015
`
`$23,935.10
`
`ma
`
`8/17/2016
`
`$14,966.64
`
`
`
`
`
`
`
`
`14
`
`15
`
`C.B.
`
`L.B.
`
`—
`,
`Ohio Medicaid
`
`16
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 17 of 19 PAGEID #: 29
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 17 of 19 PAGEID #: 29
`
`Allin violation of 18 U.S.C. §§ 1347 and 2.
`
`FORFEITURE ALLEGATIONS
`
`The GRAND JURYfurtheralleges:
`
`58.
`
`The allegations contained in Counts
`
`1
`
`through 15 of this Indictment are
`
`incorporated here for the purpose of alleging forfeiture pursuant to the provisions of Title 21,
`
`United States Code, Section 853 and Title 18, United States Code, Section 982.
`
`59.
`
`Upon conviction of a violation of Title 21, United States Code, Sections 841, as
`
`alleged in Counts | through 9 of this Indictment, defendant JIMMY HENRYshall forfeit to the
`
`United States of America any property constituting, or derived from, any proceeds obtained,
`
`directly or indirectly, as the result of such offenses and anyproperty used, or intendedto be used,
`
`in any manneror part, to commit, or to facilitate the commissionof, the offenses.
`
`60.
`
`Upon conviction of the offenses in violation of a federal health care offense,
`
`including a violation of Title 42, United States Code, Section 1320a-7b(b)(1)(B) as set forth in
`
`Count 11 and/orTitle 18, United States Code, Section 1347 as set forth in Counts 13 through 15
`
`of this Indictment, defendant JIMMY HENRYshall 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 offenses.
`
`61.
`
`Pursuant to Title 18, United States Code, Section 981(a)(1)(C) and Title 28,
`
`United States Code, Section 2461(c), upon conviction of a conspiracy to violate Title 18, United
`
`States Code, Section 1347 as set forth in Count 12 and/or Title 21, United States Code, Section
`
`841 as set forth in Count 10, in violation of Title 18, United States Code, Section 371, defendant
`17
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 18 of 19 PAGEID #: 30
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 18 of 19 PAGEID #: 30
`
`JIMMY HENRYshall forfeit to the United States of America any property, real or personal,
`
`which constitutes or is derived from proceedstraceable to said violation(s).
`
`62.
`
`The property to be forfeited includes, but is not limited to, the following:
`
`a.
`
`any property, real or personal, that constitutes or is derived, directly or
`
`indirectly, as the result of such violation:
`
`b.
`
`Ge
`
`any DEA license(s) for HENRY: and
`
`any of the defendants’ property used, or intended to be used,
`
`in any
`
`manneror part, to commit, orto facilitate the commission of, such violation.
`
`63.
`
`If any of the property described above as being subject to forfeiture, as a result of
`
`any act or omission ofthe defendant:
`
`I;
`
`il.
`
`lil.
`
`iV.
`
`V.
`
`cannot be located uponthe exercise ofdue diligence;
`
`has beentransferred or sold to, or deposited with, a third party:
`
`has been placed beyondthe jurisdiction of the Court:
`
`has been substantially diminished in value: or
`
`has been commingled with other property that cannot be subdivided
`
`withoutdifficulty;
`
`the defendants shall forfeit to the United States any other property of the defendant, up to the
`
`value of the property described above, pursuant to Title 21, United States Code, Section 853(p),
`
`as incorporated by Title 18, United States Code, Section 982(b)(1) and Title 28, United States
`
`Code, Section 2461(c).
`
`18
`
`

`

`Case: 2:20-cr-00157-ALM Doc #: 5 Filed: 09/22/20 Page: 19 of 19 PAGEID #: 31
`Case: 2:20-cr-00157-ALM Doc#: 5 Filed: 09/22/20 Page: 19 of 19 PAGEID #: 31
`
`All pursuant to Title 21, United States Code, Section 853(a), Title 18, United States
`
`Code, Section 982(a)(7), and Title 28, United States Code, Section 2461(c).
`
`A TRUE BILL:
`
`FOREPERSON
`
`DAVID M. DEVILLERS
`United States Attorney
`
`DANIEL KAHN
`Acting Chief
`Fraud Section, Criminal Division
`United States Department of Justice
`
`ALLAN J. MEDINA
`Chief, Health Care Fraud Unit
`Fraud Section, Criminal Division
`
`United States DepartmentofJustice
`
`CHRISTOPHER M. JASON
`Trial Attorney
`Health Care Fraud Unit
`Fraud Section, Criminal Division
`United States DepartmentofJustice
`
`19
`
`