Clinton Portis, 9 other ex-NFL players charged with health care fraud

 
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PostPosted: Thu Dec 12, 2019 3:55 pm    Post subject: Clinton Portis, 9 other ex-NFL players charged with health care fraud

https://profootballtalk.nbcsports.com/2019/12/12/clinton-portis-nine-other-ex-nfl-players-charged-with-health-care-fraud/

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Clinton Portis, nine other ex-NFL players charged with health care fraud

The United States Department of Justice has charged 10 former NFL players with defrauding a health care program for retired players.

Former Washington and Denver running back Clinton Portis is among those who have been charged. He is joined by Carlos Rogers, Robert McCune, John Eubanks, Tamarick Vanover, Ceandris Brown, James Butler, Frederick Bennett, Correll Buckhalter and Etric Pruitt.


Former NFL wideouts Joe Horn and Reche Caldwell are also expected to be charged with conspiracy to commit health care fraud.

The charges were filed in the Eastern District of Kentucky this week allege that the retired players submitted fradulent claims for medical equipment costing between $40,000-50,000 to the Gene Upshaw NFL Player Health Reimbursement Account Plan. They would fabricate prescriptions and invoices to support while recruiting others to make false claims in exchange for payments of up to $10,000.

“Ten former NFL players allegedly committed a brazen, multimillion dollar fraud on a health care plan meant to help their former teammates and other retired players pay legitimate, out-of-pocket medical expenses,” assistant attorney general Brian Benczkowski said, via the Washington Post. “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.”

According to the indictment, the claims filed between June 2017 and December 2018 totaled $3.9 million and the health care plan paid out more than $3.4 million.
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PostPosted: Thu Dec 12, 2019 8:34 pm    Post subject:

Sounds pretty gross if what is claimed they did is proven.
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PostPosted: Thu Dec 12, 2019 9:24 pm    Post subject:

Considering the DOJ is involved I'm sure they have a solid case.
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PostPosted: Fri Dec 13, 2019 7:38 am    Post subject:

They are facing 20 years each. That's pretty harsh for insurance fraud

Kellen Winslow Jr got less than that
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PostPosted: Fri Dec 13, 2019 8:33 am    Post subject:

LongBeachPoly wrote:
They are facing 20 years each. That's pretty harsh for insurance fraud

Kellen Winslow Jr got less than that


some of them got multiple counts of insurance fraud, wire fraud and other nasty federal white collar crimes....those all come with meaty sentences. Like I said, if proven guilty, I have no sympathy because they were stealing "from family" in a way. The fund was set up to offset medical costs for retired NFL players and is limited....as in once it's annual allotment for funding is distributed, it can not approve any new claims until the next year.

Many of these guys were recent retirees that made tens of millions of dollars in the NFL an now were simply submitting false medical claims....stealing the money. So when Johnny Bad Knees and Hips who played in the late 70's and lives on a fixed income needs a procedure, he may have to live in pain for another 6 months or be confined to his home before the fund can process his claim because those clowns stole the money.
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PostPosted: Fri Dec 13, 2019 9:24 am    Post subject:

adkindo wrote:
LongBeachPoly wrote:
They are facing 20 years each. That's pretty harsh for insurance fraud

Kellen Winslow Jr got less than that


some of them got multiple counts of insurance fraud, wire fraud and other nasty federal white collar crimes....those all come with meaty sentences. Like I said, if proven guilty, I have no sympathy because they were stealing "from family" in a way. The fund was set up to offset medical costs for retired NFL players and is limited....as in once it's annual allotment for funding is distributed, it can not approve any new claims until the next year.

Many of these guys were recent retirees that made tens of millions of dollars in the NFL an now were simply submitting false medical claims....stealing the money. So when Johnny Bad Knees and Hips who played in the late 70's and lives on a fixed income needs a procedure, he may have to live in pain for another 6 months or be confined to his home before the fund can process his claim because those clowns stole the money.


Yeah, it all adds up.

I'm just saying, when comparing it to other sentences, this one comes out pretty harsh (if they do get 20 years).
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PostPosted: Fri Dec 13, 2019 9:36 am    Post subject:

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Understanding the pyramid scheme

The accused players allegedly defrauded the Gene Upshaw NFL Player Health Reimbursement Account Plan of $3.4 million between 2017 and 2018. This $800 million plan is a collectively bargained benefit to retired players who qualify. The plan, which was established in 2006, is administered by a seven-member board of representatives appointed by the NFL or NFLPA. Cigna serves as the plan’s benefits administrator.

Funded by the NFL and its teams, the plan permits qualified NFL players to obtain reimbursement for medical expenses and medical equipment. Qualified players are those who, among reaching other benchmarks, played at least three seasons in the NFL. Along with their spouses and dependents, qualified players can use the fund to obtain tax-free reimbursements for out-of-pocket medical care expenses that aren’t covered by insurance. The potential value of the plan to each qualified player (and their families) is up to $350,000. The precise value is complicated by number of seasons played and when they played, but the takeaway is that the plan offers players and their families hundreds of thousands of tax-free dollars for health care expenses.

Reimbursement requests are made through a conventional practice. The player electronically transmits a reimbursement request form, along with supporting documentation. The claim lands at a data center in Lexington, Kentucky. From there the claim is routed to, and reviewed by, Cigna employees who are located in Lackawanna County, Pennsylvania. At that point, Cigna determines whether or not to pay. If the claim is approved, Cigna either mails a check to the retired player or makes the payment to the player through direct deposit.

This reimbursement process is ordinary and not especially complicated. The same could be said of the alleged scheme hatched by the retired players. The players are accused of submitting false claims for such pricy medical equipment as hyperbaric oxygen chambers, cryotherapy machines, ultrasound machines and electromagnetic therapy devices (designed for use on horses). In some instances, the equipment cost more than $50,000. In all instances the equipment wasn’t actually purchased.

To try to deceive Cigna, the players allegedly submitted fabricated documents that were portrayed as corroborating the request. Phony documentation included from health care providers. Such paperwork was manufactured to seem believable. To that point, false signatures of real doctors and the use of what appeared to be official letterhead were among the deceptive measures. If the government’s accusations are true, the players engaged in blatant health care fraud.

Two of the players are accused of taking additional steps to swindle. They are also portrayed as the scheme’s “ringleaders.” McCune, a linebacker who played sparingly for the Washington Redskins and Baltimore Ravens, and Buckhalter, a former running back on the Philadelphia Eagles and the Denver Broncos, allegedly dialed the telephone number provided on the reimbursement form and impersonated conspiring players. They did so to check on the status of the fraudulent claims and encourage payment as soon as possible. This was a risky move since phone calls to health care companies are sometimes recorded.

Like other health care schemes, the design of this one resembled a mafia pyramid. At the top were two ringleaders who directly and through runners recruited other players. They convinced their recruits to provide their Cigna identification numbers, social security numbers, mailing addresses and dates of birth. Such information was crucial to making credible sounding, but completely false claims. Later, when the recruited players received their ill-gotten reimbursement checks, they kick-backed several thousand dollars to the ring leaders. This process played out numerous times between 2017 and 2018. It led to $3.9 million worth of false claims, of which $3.4 million was paid out.


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The accused players are portrayed as unwittingly leaving a trail of obvious criminal activity

There was an inherent defect in the players’ scheme: it was done electronically, and thus left a digital trail for FBI agents and federal prosecutors to follow.

The Fraud Section of the Justice Department’s Criminal Division for investigation was tipped off by Cigna after company employees had detected irregularities and anomalies in certain players’ reimbursement requests. As mentioned above, those requests included reimbursement requests for medical devices that cost tens of thousands of dollars to treat horses. They also included documents that, upon inspection, were fraudulent. Cigna’s anti-fraud staff soon realized there was an abnormal pattern and conveyed that point to the Justice Department. Using data analytics and other anti-fraud measures, the FBI exposed the scheme and its masterminds.

The fact that the fraudulent activity crossed state lines—beginning with a reimbursement request filed in a player’s home state, which in turn was transmitted to Kentucky, then onto Pennsylvania and lastly, through a reimbursement check or direct deposit, back to the player’s home state—is important in terms of the Justice Department’s jurisdictional authority. Criminal activity that crosses state lines empowers the federal authorities to take action.


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The players face the real prospect of being convicted and sent to prison for years

The players face multiple counts, each of which carries a maximum prison sentence of 10 or 20 years in prison. McCune, who is considered one of the two ringleaders, faces a stunning 19 counts. Obviously, the players—particularly if they lack criminal records—would not be sentenced to many decades or hundreds of years in prison. The “maximum” sentence for a charge is usually reserved for repeat offenders and for those who engaged in exceptionally egregious conduct. Also, the presiding judge could, and probably would, choose to run all or most of the sentences concurrently, rather than consecutively.

Still, the players face the very real prospect of spending a double-digit number of years in federal prison if they go to trial and are convicted. Although every case is different, a few months ago a health care facility owner was sentenced to 20 years in prison and, in a separate case, a hospital administrator was sentenced to 10 years in prison. Both defendants were guilty of federal health care fraud charges. Health care fraud, particularly when coupled with other kinds of fraud, often attracts lengthy sentences. This is because the convicted defendants essentially stole funds used to pay deserving persons.

The prospect of a conviction is also quite real with federal charges. Federal prosecutors obtain convictions at a rate of 85% to 95%. Faced with these daunting odds, about 90% of federal defendants plead guilty as part of plea deals and hope for leniency in sentencing.


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Law-abiding retired NFL players and their families should be concerned

It’s important to not paint retired NFL players with a broad brush. There are more than 20,000 retired NFL players, many of whom qualify for the reimbursement plan and many of whom have family members who are also covered. A fraction of one percent of retired players engaging in wrongful acts should not raise questions about the other 99%. Many retired NFL players have significant health care needs—it’s been said every retired NFL player has a preexisting condition—and lawfully rely on health care benefits. They are the real victims of fraud.

Benczkowski alluded to that point when warning that the reimbursement plan’s tax-exempt status is endangered by fraudulent activity. The accused players have “threatened the ability of law-abiding former players to continue to receive tax-free reimbursements for legitimate medical expenses for themselves or their families.” To that point, the Internal Revenue Service could review whether the plan remains compliant under federal law governing health plans and tax-exempt reimbursements.

If the plan lost its tax-exempt status, thousands of retired players would lose an important benefit that the NFLPA negotiated through collective bargaining. Players would then need to pay taxes on reimbursed funds on legitimate medical expenses for themselves or their families


https://www.si.com/nfl/2019/12/12/analyzing-football-health-care-fraud-case
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PostPosted: Sat Dec 21, 2019 11:47 am    Post subject:

https://profootballtalk.nbcsports.com/2019/12/20/joe-horn-pleads-guilty-to-defrauding-fund-for-retired-players-health-care/

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Joe Horn pleads guilty to defrauding fund for retired players’ health care

Former NFL wide receiver Joe Horn has pleaded guilty to conspiring to defraud a health plan, the first conviction in a case that has seen 12 retired NFL players accused of ripping off the Gene Upshaw NFL Player Health Reimbursement Account Plan, a program designed to help them with their medical needs.

Horn submitted $149,775 in false or fraudulent claims to the health plan, according to the Lexington Herald Leader. None of the players live in Kentucky, but the players are being prosecuted in federal court there because they submitted their claims to a health care data center in Lexington.

Former players are accused of faking invoices claiming to have purchased expensive equipment such as hyperbaric chambers, cryotherapy machines, ultrasound machines and electromagnetic therapy devices designed for use on horses, then submitting those invoices to the fund and asking for reimbursement.

Former NFL players Robert McCune and Correll Buckhalter are accused of recruiting other former players into the scheme and offering to handle fraudulent claims on their behalf in exchange for $10,000 of the proceeds.

Horn will not be sentenced until April. It is believed that his guilty plea was part of a deal that will see him get a lighter sentence in exchange for providing information about other accused players.

In addition to Horn, McCune and Buckhalter, the players facing criminal charges are Clinton Portis, John Eubanks, Tamarick Vanover, Carlos Rogers, Ceandris Brown, James Butler, Fredrick Bennett and Etric Pruitt. Reche Caldwell has not been charged, but prosecutors say they plan to bring charges against him.

Horn’s life story was, until now, an uplifting one: He played his college football only at the community college level and had quit football altogether before managing to get a tryout with a Canadian Football League team in 1995 and bursting onto the scene with a 1,000-yard rookie season in the CFL that year. The next year he went to the NFL, where he played four years with the Chiefs and then signed with the Saints in 2000, where he was a four-time Pro Bowler.
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PostPosted: Thu Jan 06, 2022 6:24 pm    Post subject:

https://profootballtalk.nbcsports.com/2022/01/06/clinton-portis-sentenced-to-six-months-in-prison-for-healthcare-fraud/

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Clinton Portis sentenced to six months in prison for healthcare fraud

Former NFL running back Clinton Portis will serve prison time for healthcare fraud.

Portis was sentenced to six months in prison today for a scheme to falsely claim he purchased expensive medical equipment and then submit receipts for reimbursement to the Gene Upshaw NFL Player Health Reimbursement Account Plan, which helps retired NFL players pay for healthcare costs.

U.S. District Judge Karen K. Caldwell said at the sentencing hearing that although Portis pleaded guilty, he has not owned up to what he did, according to the Lexington Herald-Leader.

Washington Football Team owners Dan and Tanya Snyder wrote a letter to Caldwell on Portis’s behalf, urging leniency.

“Clinton’s generosity is legendary, but so is his trust in others, which sometimes proves misplaced,” the Snyders wrote in. “It has been hard over the years to see Clinton taken advantage of by those who have abused his trust. We were shocked when Clinton was indicted in this case. Not because Clinton got wrapped up in something where others did not have his best interest in mind, but because Clinton is the opposite of a criminal.”

Portis is one of 15 former NFL players charged in the fraud case, and the 10th sentenced. Former Saints receiver Joe Horn quickly pleaded guilty and agreed to cooperate with the investigation, and he was not sentenced to prison time. The others — Correll Buckhalter, John Eubanks, Etric Pruitt, James Butler, Ceandris Brown, Carlos Rogers, Anthony Montgomery, Darrell Reid and Frederick Bennett — have received sentences ranging from home confinement to a year and a half in prison.
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