On Thursday night, the U.S. Department of Justice announced to the sports world that it was charging ten former NFL players, including the former Washington Redskins running back Clinton Portis, in a nationwide scheme to defraud a health care benefit program for retired NFL players.
The alleged fraud targeted the Gene Upshaw NFL Player Health Reimbursement Account Plan (the “Plan”), which was established pursuant to the 2006 collective bargaining agreement and provided for tax-free reimbursement of out-of-pocket medical care expenses that were not covered by insurance and that were incurred by former players, their wives, and their dependents–up to a maximum of $350,000 per player.
Named after the late Gene Upshaw, who served at one point as the head of the NFLPA, the Plan is in place for the benefit of the NFL’s retired, ill players.
It’s important to note that the Plan is separate from the class-action settlement between the NFL and retired players, which pays up to $5 million to players with neurological and cognitive diseases, including Alzeimer’s disease.
But get this. Over $3.9 million in false and fraudulent claims were submitted to the Plan, according to the indictment, and the Plan actually paid out over $3.4 million on those claims between June 2017 and December 2018.
“Today’s indictments underscore that whoever you are, if you loot health care programs to line your own pockets, you will be held accountable by the Department of Justice,” the Assistant Attorney General Brian Benczkowski.
“Ten former NFL players allegedly committed a brazen, multi-million dollar fraud on a health care plan meant to help their former teammates and other retired players pay legitimate, out-of-pocket medical expenses.”
Reading through the indictment, ten former NFL players were named, including:
- Robert McCune, 40, of Riverdale, Georgia, is charged with one count of conspiracy to commit wire fraud and health care fraud, nine counts of wire fraud and nine counts of health care fraud.
- John Eubanks, 36, of Cleveland, Mississippi; Tamarick Vanover, 45, of Tallahassee, Florida; and Carlos Rogers, 38, of Alpharetta, Georgia, are each charged with one count of conspiracy to commit wire fraud and health care fraud, two counts of wire fraud and two counts of health care fraud.
- Clinton Portis, 38, of McLean, Virginia; Ceandris Brown, 36, of Fresno, Texas; James Butler, 37, of Atlanta, Georgia; and Fredrick Bennett, 35, of Port Wentworth, Georgia, are each charged with one count of conspiracy to commit wire fraud and health care fraud, one count of wire fraud and one count of health care fraud.
- Correll Buckhalter, 41, of Colleyville, Texas, and Etric Pruitt, 38, of Theodore, Alabama, are charged with one count of conspiracy to commit wire fraud and health care fraud.
“The defendants are alleged to have developed and executed a fraudulent scheme to undermine a health care benefit plan established by the NFL – one established to help their former teammates and colleagues pay for legitimate medical expenses,” said U.S. Attorney Robert M. Duncan Jr., for the Eastern District of Kentucky.
“The defendants allegedly submitted false claims to the plan and obtained money for expensive medical equipment that was never purchased or received, depriving that plan of valuable resources to help others meet their medical needs. We have prioritized the investigation and prosecution of health care fraud in our office, and we appreciate the partnership we share with the Criminal Division and the FBI in pursuing these important matters.”
But this isn’t an incident isolated to the NFL, as this investigation, as emphasized by FBI Special Agent in Charge George L. Piro of the Miami Field Office, “serves as an illustration of the rampant and deliberate scams against health care plans occurring daily throughout the country.”
And in this case, there are over 20 FBI field offices participating in this investigation, demonstrating the level and type of commitment the agency has to protecting not just the Plan, but preventing this type of fraud altogether.
Collaboratively, the investigation has been conducted by the following FBI Field Offices and Resident Agencies — Augusta, Georgia; Birmingham and Mobile, Alabama; Cleveland, Ohio; Chicago, Illinois; Columbia, South Carolina; Dallas and Houston, Texas; Denver, Colorado; Jackson, Mississippi; Lexington, Kentucky; New Orleans, Louisiana; Miami, Jacksonville and Tampa, Florida; Newark, New Jersey; Los Angeles, San Diego, Sacramento and Newport Beach, California; Phoenix, Arizona; Salt Lake City, Utah; and Washington, D.C.
“In this case, these fraudsters pocketed money from the Gene Upshaw National Football League Health Reimbursement Account Plan that was intended for former NFL players who are ill or infirm,” Piro added.
In addition to the players mentioned above, the government has filed notice that it intends to file criminal informations charging Joseph Horn, 47, of Columbia, South Carolina, and Donald “Reche” Caldwell, 40, of Tampa, Florida, with conspiracy to commit health care fraud in the Eastern District of Kentucky.
Per the indictments, the scheme to defraud involved the submission of false and fraudulent claims to the PLan for expensive medical equipment, which included claims ranging between $40,000 and $50,000 for each claim.
The expensive medical equipment described on the false and fraudulent claims included hyperbaric oxygen chambers, cryotherapy machines, ultrasound machines designed for use by a doctor’s office to conduct women’s health examinations and electromagnetic therapy devices designed for use on horses.
The scheme went so far as to recruit other players by offering to submit or cause the submission of these false and fraudulent claims in exchange for kickbacks and bribes that ranged from a few thousand dollars to $10,000 or more per claim submitted. This required the named defendants to allegedly provide “supporting, fabricated documentation” for the claims, which included invoices, prescriptions and letters of medical necessity. After the claims were submitted, McCune and Buckhalter allegedly called the telephone number provided by the Plan and impersonated certain other players in order to check on the status of the false and fraudulent claims.