MM Curator summary
[MM Curator Summary]: A pharmacy scheme run in locations owned by a former legislator stole $2.7M from Medicaid.
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A former Kentucky legislator pleaded guilty in federal court Wednesday to health care fraud and a financial crime.
Robert Goforth, 46, admitted that a pharmacy he owned in Clay County billed insurance programs, including Medicare and Medicaid, for prescriptions that customers didn’t pick up.
The medication could then be put back on the shelf and sold again.
“I knew that it was wrong and I’m here to own up to that and take responsibility for my actions,” Goforth said in a hearing before U.S. District Judge Robert E. Wier in London.
Goforth agreed as part of his plea not to appeal any sentence up to three years and one month in prison.
Goforth pleaded guilty to one charge of health care fraud and one charge related to money laundering, acknowledging he wrote a $17,000 check from an account that contained at least some money derived from the fraud.
Each charge carries a maximum sentence of 10 years in prison. Goforth’s sentence will likely be less than that under advisory guidelines.
Federal prosecutors charged Goforth by way of a document called an information. That is a way to file a charge without presenting the case to a grand jury.
Goforth said at the hearing a state pharmacy investigator told him in 2015 about suspected fraud by an employee involving prescriptions not being picked up.
The employee received a percentage of the store’s profits, Goforth said.
Goforth said the normal procedure if a customer didn’t pick up a prescription would be to credit the charge back to the insurance provider.
However, after looking into the situation and seeing discrepancies, he ignored the problem and allowed the improper billing to continue for several months, Goforth said.
“I had a responsibility to stop it and I did not do that,” he said in court.
Goforth conceded in his plea agreement that about $2.7 in excessive billing occurred at the Manchester pharmacy from when he started it until he sold it in September 2016. Of that, about $1.35 million happened after he was put on notice about the problem.
Most of his business came from Medicare and Medicaid, meaning that after he was notified of the fraud, there was $945,000 in false billing to the government programs, according to the plea agreement.
The total restitution in the case is $2.7 million.
Wier could have ordered Goforth detained until sentencing, but allowed him to remain out of jail. Prosecutors had agreed to recommend allowing him to remain free.
Wier scheduled sentencing in September.
Goforth, a Republican, represented Jackson County and parts of Laurel and Madison counties in the state House before resigning in August 2021 as he faced a charge in state court of strangling his wife during a domestic dispute in April 2020.
That charge is pending.
Goforth also ran unsuccessfully for the GOP nomination for governor in 2019.
This story was originally published May 25, 2022 4:36 PM.
Clipped from: https://www.kentucky.com/news/local/crime/article261794992Rober.html