Former Georgia State Insurance Commissioner John Oxendine has pleaded guilty to federal charges related to a healthcare fraud scheme, where he conspired to submit fraudulent insurance claims for medically unnecessary testing. The scheme involved major healthcare providers and resulted in significant financial losses. Oxendine’s guilty plea marks a significant downfall for a once-prominent politician.
Former Georgia State Insurance Commissioner Pleads Guilty to Healthcare Fraud Charges
Former Georgia State Insurance Commissioner John Oxendine has pleaded guilty to federal charges related to a healthcare fraud scheme. Oxendine, who served as the insurance commissioner for four consecutive terms from 1995 to 2011, appeared in federal court on Friday and entered a guilty plea for conspiracy to commit health care fraud.
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Oxendine’s guilty plea marks a significant downfall for a once-prominent politician. In 2010, he entered the race for the Republican nomination for governor but ultimately finished behind other candidates, including eventual winner Nathan Deal.
( Credit to: Fox5atlanta )
Oxendine is scheduled to be sentenced by a federal judge on July 12. His guilty plea serves as a reminder of the importance of integrity and ethical conduct in the healthcare industry and the consequences that can result from fraudulent practices.
Conspiracy to Commit Health Care Fraud
According to the indictment, Oxendine conspired with others to submit fraudulent insurance claims to major healthcare providers, including Aetna, Blue Cross Blue Shield, and United Healthcare. The claims were for medically unnecessary testing, and the scheme involved pressuring physicians associated with the ENT practice of Dr. Jeffrey Gallups to order these tests.
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The indictment further revealed that the testing was carried out by a lab in Texas called Next Health. As part of the scheme, Next Health, Oxendine, and Gallups had an agreement where the doctor would receive a kickback of 50% of the net profit for eligible specimens submitted by his practice for testing. Insurance companies paid Next Health nearly $700,000, and some patients were also charged for the unnecessary tests, resulting in bills as high as $18,000.
Concealing Kickbacks and Financial Impact
To conceal the kickbacks, payments were made from Next Health to Oxendine’s insurance consultant business. Oxendine then kept a portion of the kickback money for himself and used another portion to pay off debts to Gallups.
The financial impact of this healthcare fraud scheme was significant, with insurance companies paying out nearly $700,000 for medically unnecessary tests. Some patients were also burdened with high bills for these unnecessary tests, further highlighting the negative consequences of fraudulent practices in the healthcare industry.
Accountability and Public Trust
U.S. Attorney Ryan K. Buchanan expressed disappointment in Oxendine’s actions, stating, “John Oxendine, as the former statewide insurance commissioner, knew the importance of honest dealings between doctors and insurance companies. But for personal profit, he willfully conspired with a physician to order hundreds of unnecessary lab tests, costing hundreds of thousands of dollars. He will now be held accountable for violating the public’s trust.”
This case serves as a reminder of the importance of integrity and ethical conduct in the healthcare industry. It underscores the need for individuals in positions of power and influence to act responsibly and prioritize the well-being of patients and the public over personal gain.
Sentencing and Downfall
Oxendine’s guilty plea marks a significant downfall for a politician who was once seen as a rising star in Georgia politics. In 2010, he entered the race for the Republican nomination for governor but ultimately finished behind other candidates, including eventual winner Nathan Deal.
Oxendine is scheduled to be sentenced by a federal judge on July 12. The outcome of his sentencing will determine the consequences he will face for his involvement in the healthcare fraud scheme.
