Former Rogers Company Executive Pleads Guilty To Role In Workers’ Comp Billing Fraud Conspiracy
FAYETTEVILLE, AR — Amanda Dawn Rains, a former executive with a Rogers medical supply and billing company, pleaded guilty today to one count of conspiracy to commit mail fraud, wire fraud, health care fraud, fraud to obtain federal employees’ compensation, and illegal remunerations. This was in connection with a scheme to defraud the U.S. government and private insurance companies by over-billing for unnecessary medications provided to workers’ compensation patients. The fraud scheme ran from 2011 until 2017 and defrauded both federal and private workers’ compensation insurers.
According to court documents, the premise of the scheme centered around individuals associated with the Rogers corporation who recruited physicians to dispense pain creams and patches to their workers’ compensation patients by offering them a 50 percent split of the profits collected from successfully billing insurers. The company would supply the physicians with pain creams and patches and act as the billing agent. They would handle all of the paperwork and submit the allegedly fraudulent claims to the U.S. Department of Labor, Office of Workers’ Compensation Programs, as well as to private insurers. The company billed insurers at markups of anywhere from 15 to 20 times what the medications actually cost, and then paid the physicians kickbacks on amounts collected.
Court documents allege that Rains managed the billing system for the Rogers corporation, electronically submitted fraudulent claims, maintained a “do not dispense” list of insurers that refused to pay the claims, advised doctors on how to respond to inquiries by the insurance companies, shipped the medications to doctors and clinics, and prepared presentations to be used by sales representatives to recruit doctors by falsely stating that the arrangement did not violate anti-kickback laws.
As a result of her guilty plea, she may be sentenced to a maximum of five years in prison. Her sentence will be determined at a later date. She has also agreed to pay restitution to the Department of Labor and other insurers targeted in the scheme.