Pharmacy owner sentenced in $41 million insurance fraud case
Ivor Jallah, 37, pleaded guilty earlier this year and has been sentenced to 120 months in federal prison.
Photo: Chris Ryan/Getty Images
A Dallas pharmacy owner who routinely billed insurance companies for headache sprays, pain creams and scar creams never dispersed to patients has been sentenced to 10 years in federal prison, according to the U.S. Department of Justice.
Ivor Jallah, 37, was indicted in November 2020 and pleaded guilty in June of this year to conspiracy to commit healthcare fraud. He was sentenced Monday by U.S. District Judge Sam A. Lindsay to 120 months in federal prison and ordered to pay more than $41 million in restitution.
Ivor's co-conspirator, Shannon Turley, 46, pleaded guilty in November 2023 to conspiracy to commit healthcare fraud and is set to be sentenced in November.
WHAT'S THE IMPACT
According to plea papers, Jallah and Turley – who together operated at least nine Texas pharmacies, including Preferred RX, EZ Pharmacy, Avenue H Pharmacy and Wallis Pharmacy – paid individuals they referred to as "marketers" for insured patients' personally identifiable information.
Some patients were aware of the scheme and required the marketers to pay a fee for their information; others were oblivious to the fraud.
Jallah and Turley caused employees to input the patient information onto prepopulated prescription pads, said the DOJ. In some cases, they paid physicians to fraudulently stamp prescription forms when they had not seen patients, while in other cases they used physicians' stamps without their knowledge.
Initially, the pharmacies shipped out a fraction of the medications they billed to insurance. At some point, however, Jallah decided to stop shipping out any medication they billed to insurance.
When insurance companies conducted audits to determine whether the prescription claims were legitimate, Jallah and Turley fabricated drug purchase invoices to support the claims they submitted to insurance.
Jallah also directed pharmacy employees to create fake prescription delivery logs and directed the "marketers" to ask patients to sign the logs regardless of whether they received prescriptions. In cases where the marketers could not obtain patient signatures, Jallah directed pharmacy employees to forge them, the DOJ said.
Over the course of the scheme, Jallah and Turley submitted at least $46 million in bogus claims to insurers, $41 million of which were reimbursed.
THE LARGER TREND
Eight defendants have previously pled guilty to charges associated with the pharmacy fraud and been sentenced to a combined 290 months in prison. Two other defendants await sentencing.
ON THE RECORD
"By billing for prescription medication patients never needed nor received, these defendants brazenly lined their pockets at the expense of each and every client who paid into health insurance," said U.S. Attorney Leigha Simonton. "Healthcare is already a significant expense for many Americans. We cannot and will not allow pharmacy operators to abuse the system in this way."
"Healthcare fraud schemes are more complex, more resource-consuming, and more costly to the American taxpayer than ever," said Dallas FBI Acting Special Agent in Charge P. J. O'Brien. "For this defendant, as one avenue to personal enrichment ran its course, he simply began operating a new pharmacy or engaging in a new method to circumvent existing system safeguards. From fraudulent credentials to fabricated invoices, the conspiracy was designed to thwart detection. The FBI will continue to work with our partners from the Northern District of Texas, Texas Department of Insurance, and others to bring justice to criminals who attempt to undermine our healthcare system."
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.
