An Arizona couple pleaded guilty for causing over $1.2 billion of false and fraudulent claims to be submitted to Medicare and other health insurance programs for expensive, medically unnecessary wound grafts that were applied to elderly and terminally ill patients. According to court documents, Alexandra Gehrke, 39, and her husband, Jeffrey King, 46, both of Phoenix, conspired with others to orchestrate the massive scheme. Gehrke ran two companies, Apex Medical LLC and Viking Medical Consultants LLC, that contracted with medically untrained “sales representatives” to locate elderly patients, including hospice patients, who had wounds at any stage and order amniotic wound grafts from a specific graft distributor. Gehrke instructed and financially incentivized the sales representatives to order grafts only in sizes 4×6 centimeters or larger, even if the wound was much smaller, to maximize health insurance reimbursement.
Gehrke, through companies she owned and controlled, received over $279 million in illegal kickbacks from the distributor of the grafts in exchange for the orders. Gehrke in turn paid the sales representatives tens of millions of dollars in unlawful kickbacks. Gehrke then referred the patients to a company co-owned by King, which contracted with nurse practitioners to apply the grafts. King’s company fraudulently billed Medicare, TRICARE (the healthcare program for US service members and their families), CHAMPVA (the healthcare program for spouses and children of permanently disabled veterans), and commercial insurance plans for the grafts. Gehrke and King, who had no medical training, directed the nurse practitioners to suspend their own medical judgment and apply all grafts ordered by the sales representatives, even when medically unreasonable and unnecessary, which resulted in the application of grafts to infected wounds, wounds that had already healed, and wounds that were not responding to the grafts.
