Washington, DC - Assistant Attorney General Brian Benczkowski Delivers Remarks at the Former NFL Player Health Care Benefit Program Fraud
Good morning, and thank you for being here.
Today, we are announcing charges against 10 former National Football League players who are accused of defrauding an NFL health care program meant to benefit retired players and their families.
These former players have been charged in two separate indictments with conspiracy, wire fraud, and health care fraud, for submitting fraudulent claims to the healthcare plan for expensive medical equipment that was never purchased and never received.
The cases have been indicted in Lexington, in the Eastern District of Kentucky.
The charges we are announcing today are merely allegations, and each of the defendants is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
The Gene Upshaw NFL Player Health Reimbursement Account Plan (“the Plan”) provides for tax-free reimbursement of out-of-pocket medical care expenses incurred by eligible former players, their spouses, and their dependents.
Once eligible players retire, they are not taxed on reimbursements from the Plan, so long as those reimbursements are for actual medical care expenses they have incurred.
As outlined in the indictments, a group of former players brazenly defrauded the Plan by seeking reimbursement for expensive medical equipment that they never purchased.
Things like hyperbaric oxygen chambers, ultrasound machines used by doctor’s offices to conduct women’s health exams, and even electromagnetic therapy devices designed for use on horses.
As a result of the fraud, more than $3.9 million in phony claims were submitted to the Plan, and the Plan paid out approximately $3.4 million on those claims between mid-2017 and mid-2018.
The two indictments involve different players, but the crimes charged were carried out in almost identical fashion.
The ringleaders of the fraud recruited other eligible former players by offering to submit or assist in submitting fake claims to the Plan.
In exchange, the ringleaders demanded kickbacks ranging from a few thousand dollars to $10,000 or more for each fraudulent claim.
If a participant agreed to this scheme, the leaders and recruiters obtained personal information from them, so that the information could be used to complete and submit a false claim on their behalf.
In each case, the forms submitted in support of the claim were completely fabricated. This included things like fake invoices from medical supply companies, and forged letters and prescriptions from medical care providers.
The exact size of each claim varied, but they were typically in the range of $40,000 to $50,000 each.
When a defendant received his reimbursement check, he then kicked back the agreed-upon amount to the ringleader or recruiter.
This process was repeated over and over again, placing the integrity of the Plan at risk.
By defrauding the Plan and treating it like their own personal ATM machine, sadly, the defendants placed the Plan’s tax exempt status at risk and threatened the ability of law-abiding former players to continue to receive tax-free reimbursements for legitimate medical expenses for themselves or their families.
The fraud only stopped when CIGNA detected it, began refusing to pay claims, and then referred the matter to the Fraud Section of the Department of Justice’s Criminal Division for investigation.
I want to thank our partners who have worked hard on this case:
- The U.S. Attorney’s Office for the Eastern District of Kentucky, including U.S. Attorney Robert Duncan; and
- The FBI, specifically George Piro, the Special Agent in Charge of FBI’s Miami Field Office, as well as the supervisors and agents on the health care fraud squad who investigated this case, and multiple FBI field offices around the country who assisted with the investigation.
And I want to note that the investigation is still ongoing.
It is now my pleasure to introduce my colleague, Robert Duncan, the U.S. Attorney for the Eastern District of Kentucky.