Sea Pines man charged with 24 federal counts in $56 million Medicare scam, officials say
A Hilton Head Island man was recently charged with 24 federal counts alleging he was part of a $2.1 billion Medicare scheme that targeted the elderly across four states, according to a Department of Justice press release.
James “Jamie” L. Simmons, 62, is accused of fraudulently billing Medicare for more than $56 million. He was arrested in “one of the largest healthcare fraud schemes ever charged,” after a joint investigation by the FBI, U.S. Department of Justice Criminal Division, and the U.S. Department of Health and Human Services Office of the Inspector General, according to a Department of Justice press release.
The investigation found a total of 35 individuals, including doctors and CEOs, who billed Medicare programs more than $2.1 billion for fraudulent Cancer Genomic (CGx) tests, which can detect a patient’s risk for cancer with DNA samples, according to the Department of Justice.
“The defendants are alleged to have capitalized on the fears of elderly Americans in order to induce them to sign up for unnecessary or non-existent cancer screening tests,” said U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, where Simmons was charged. “The genetic testing fraud schemes put personal greed above the preservation of the American health care system.”
Genetic-testing fraud is the fastest-growing form of Medicare fraud and “it’s costing the U.S. government billions in taxpayer dollars,” the Miami Herald reported.
Simmons, who lives in Sea Pines, was charged with 24 total counts: conspiracy to commit health care and wire fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, health care fraud and receiving kickbacks related to a federal health care program, according to a Sept. 27 indictment.
He founded two medical technology companies called MedSymphony and Meetmydoc LLC, according to court documents. Meetmydoc’s primary location is on Calibogue Cay Road in Sea Pines, where Simmons lives, while MedSymphony is based in Florida. These companies connect patients to doctors through technology for prescriptions and diagnosis.
Simmons’ companies allegedly marketed CGx tests to elderly and disabled patients on Medicare, according to court documents. However, the tests were deemed medically unnecessary to many patients, considering they don’t diagnose cancer.
Simmons, along with other unnamed co-conspirators, billed Medicare programs $56,342,796 for fraudulent CGx tests that were not eligible for Medicare reimbursement, but were authorized by Medsymphony doctors from January 2018 through September 2019, according court documents. Medicare paid companies affiliated with Simmons $17 million of that total.
The indictment lists 15 patients whose Medicare accounts were billed between $850 and $11,900 for these tests.
Simmons supplied fraudulent Medicare-required documents written by doctors contracted with Medsymphony for the CGx tests, “even though those doctors were not treating the patients for cancer,” according to the indictment. The doctors “often” never contacted the patients they were issuing the tests for, according to the indictment. Nor did they use results from the tests to treat the patients.
Simmons is accused of “paying and receiving kickbacks in exchange for the referral of Medicare beneficiaries” so that laboratories could bill Medicare for CGx tests, “without regard to whether the beneficiaries needed the tests.”
He’s also accused of “concealing the submission of false and fraudulent claims to Medicare and Medicare Advantage plans” and “diverting fraud proceeds for (his) personal use and benefit, the use and benefit of others and to further the fraud,” the press release said.
Simmons faces 20 years in prison for conspiracy to commit health care fraud, 20 years for health care fraud, five years for conspiracy to defraud the U.S. and receive kickbacks, and 10 years in prison for receipt of kickbacks from a federal health care program.
On the day he was charged, Simmons voluntarily surrendered and appeared in District Court in South Carolina, according to Peter Carr, spokesperson for the Criminal Division of the Department of Justice.
Simmons was granted a $150,000 bond in federal court on Oct. 15, according to online documents, and has not spent any time in custody, Carr said. As a part of his bond agreement, Simmons was asked to surrender all passports and charging documents and submit to substance abuse and mental health testing and/ or treatment. He was also ordered to “refrain from possessing a firearm,” according to court documents.
Simmons has also been instructed not to handle any services that can be billed through government health care, according to his bond agreement. Those conditions also apply to his two companies.
He is free on bond until his trial date, which is set for Oct. 28, but federal prosecutors have asked to postpone the trial until July 13, Carr said.
This story was originally published October 24, 2019 at 11:10 AM.
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