Former Georgia Insurance Commissioner John Oxendine pleads guilty to health care fraud

Former Georgia Insurance Commissioner John Oxendine pleads guilty to health care fraud
Former Georgia Insurance Commissioner John Oxendine pleads guilty to health care fraud

ATLANTA (AP) — A former Georgia insurance commissioner who made an unsuccessful Republican bid for governor has pleaded guilty to conspiracy to commit health care fraud.

John W. Oxendine of Johns Creek pleaded guilty Friday in federal court in Atlanta. The 61-year-old was indicted in May 2022 on charges of conspiracy to commit health care fraud and conspiracy to commit money laundering.

The offense is punishable by up to 10 years in prison, but Oxendine is likely to be sentenced to less. The federal sentencing guidelines discussed in the plea agreement suggest prosecutors will recommend Oxendine be sentenced to between 4 years, 3 months and 5 years, 3 months, depending on U.S. District Judge Steve Jones’ decision during a sentencing hearing scheduled for July 12. Jones could also fine Oxendine and order him to serve supervised release.

Oxendine also agreed to pay nearly $700,000 in restitution to health insurance companies that lost money in the scheme, the filing states. Prosecutors agreed to drop the money laundering charge as part of the indictment.

«John Oxendine, as a former state insurance commissioner, knew the importance of fair dealing between doctors and insurance companies,» U.S. Attorney Ryan K. Buchanan it said in a statement. «But for personal gain, he deliberately conspired with a doctor to order hundreds of unnecessary lab tests costing hundreds of thousands of dollars.»

Prosecutors allege that Oxendine conspired with Dr. Jeffrey Gallups to pressure other doctors who practiced with Gallups to order unnecessary medical tests from Next Health, a Texas lab. Prosecutors said Oxendine pushed the plan in a September 2015 presentation to doctors who worked for Gallup’s practice.

The lab company, Oxendine and Gallups agreed that the company would pay Gallups 50% of the profits from the tests, Oxendine’s indictment said. Next Health paid $260,000 in kickbacks through Oxendine’s insurance consulting company, prosecutors said. Oxendine paid a $150,000 charitable contribution and $70,000 in legal fees to the Gallups,” prosecutors said, keeping $40,000 for themselves.

Some patients were also charged, receiving bills of up to $18,000 for the tests, prosecutors said.

Prosecutors said Oxendine told Gallups to lie and say the payments from Oxendine were loans when a compliance officer at Gallups’ company asked about them. Oxendine told Gallups to repeat the same lie when questioned by federal agents, prosecutors said. And they said Oxendine falsely said he did not work with the lab company or receive money from Next Health when interviewed by The Atlanta Journal-Constitution.

Gallups pleaded guilty in October 2021 to one count of health care fraud after he waived charges. Gallups was sentenced to three years in prison in June 2022. He was also ordered to pay $700,000 in restitution and was fined $25,000.

In 2021 Gallups agreed to pay $3 million after a whistleblower filed suit alleging Gallups defrauded the federal government through the Next Health scheme and a bribery scheme with a separate medical device company. That amount was grew to nearly $5.4 million in March because Gallups and his company, Milton Hall Surgical Associates, failed to pay the original amount within a year.

Next Health faces other fraud charges. The company and related individuals and entities were ordered to pay health insurer UnitedHealth $218 million in a Texas lawsuit in 2023.

Oxendine served as an elected state insurance commissioner from 1995 to 2011. He ran for governor in 2010 but lost the Republican primary. The state Ethics Commission began investigating and prosecuting campaign finance charges against him in 2009, alleging Oxendine violated state law by using campaign funds to buy a house, lease luxury cars and join a private club.

Oxendine settled this case with the Georgia Ethics Commission in 2022, agreeing to turn over the remaining $128,000 to his campaign fund while admitting no wrongdoing.

He was also accused of accepting a bundled contribution of $120,000, 10 times the legal limit, from two Georgia insurance companies in 2008 when he ran for governor. Judge convicts government officials I waited too long to prosecute Oxendine on these charges.

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