John W. Oxendine, the former Georgia State Insurance Commissioner, pleaded guilty to conspiracy to commit healthcare fraud in which a co-conspirator and he referred unnecessary medical tests to a lab company in Texas in return for hundreds of thousands of dollars in kickbacks. According to US Attorney Buchanan, the charges and other information presented in court: John Oxendine conspired with Dr. Jeffrey Gallups and others to submit fraudulent insurance claims for medically unnecessary Pharmacogenetic, Molecular Genetic, and Toxicology testing. Physicians associated with Dr. Gallups’s ENT practice were pressured to order these medically unnecessary tests from Next Health, a lab in Texas.
As part of Oxedine’s healthcare fraud scheme, Next Health agreed to pay Oxendine and Dr. Gallups a kickback of 50 percent of the net profit for eligible specimens submitted by Dr. Gallups’s practice to the lab company. In connection with the scheme, Oxendine gave a presentation at the Ritz Carlton in Buckhead where he pressured doctors in Dr. Gallups’s practice to order the unnecessary tests. Next Health later submitted insurance claims seeking more than $2,500,000 in payments from private health insurers for the unnecessary tests. The insurance companies paid almost $700,000 to Next Health because of these fraudulent claims. Next Health then paid $260,000 in kickbacks to Oxendine and Dr. Gallups. Some patients were also charged for the tests, receiving bills of up to $18,000.
To conceal the kickback payments, Oxendine and Dr. Gallups arranged for the payments to be made from Next Health to Oxendine Insurance Services, Oxendine’s insurance consulting business. Oxendine used a portion of the kickback money to pay debts for Dr. Gallups: a $150,000 charitable contribution and $70,000 in attorney’s fees. When a compliance officer at Dr. Gallups’s practice raised concerns about the kickbacks, Oxendine told Dr. Gallups to lie and say the payments from Oxendine to Dr. Gallups were loans. He directed Dr. Gallups to repeat the lie after he was questioned by federal agents about Next Health. And when interviewed about Next Health by the Atlanta Journal-Constitution in connection with a private lawsuit, Oxendine falsely denied working with the lab company or receiving money from the business.
