Ten former National Football League (NFL) players face prosecution for their alleged roles in a nationwide health care fraud scam that Justice Department prosecutors allegedly defrauded the Gene Upshaw NFL Player Health Reimbursement Account Plan (the “Plan)” by submitting more than $3.9 million in false and fraudulent claims between June 2017 and December 2018.
According to the charges brought in two separated indictments filed December 12, 2019 in the Eastern District of Kentucky, the charged players participated in a nationwide conspiracy that resulted in the submission of more than $3.9 million in false claims to the Plan, for which the Plan paid out over $3.4 million between June 2017 and December 2018. See Buckhalter and Rogers Indictment; McCune et al Indictment. The Plan established pursuant to the 2006 collective bargaining agreement between the NFL and payers provides a health care reimbursement account to reimburse up to a maximum of $350,000 per player of out-of-pocket medical care expenses a former player, his wife or dependents incurs not covered by insurance.
The indictments charge that the scheme to defraud involved the submission of false and fraudulent claims to the Plan for expensive medical equipment – typically between $40,000 and $50,000 for each claim never purchased or received. The expensive medical equipment described on the false and fraudulent claims included hyperbaric oxygen chambers, cryotherapy machines, ultrasound machines designed for use by a doctor’s office to conduct women’s health examinations and electromagnetic therapy devices designed for use on horses. The indicatments reflect that no health care providers participated in the scheme. Rather the players submitted these allegedly false charges without any health care provider participation.
Charged in the two separated indictments include the following former NFL players including five former Washington Redskins. Those charged and the charges brought include the following:
- Charges of one count of conspiracy to commit wire fraud and health care fraud, nine counts of wire fraud and nine counts of health care fraud brought against former NFL linebacker Robert McCune, McCune’s career included stints with the Washington Redskins, Miami Dolphins, Baltimore Ravens and Cleveland Browns between 2005 and 2009;
- Charges of one count of conspiracy to commit wire fraud and health care fraud, two counts of wire fraud and two counts of health care fraud made against:
- Former Washington Redskins cornerback John Eubanks who was draft but only played as a practice squad player with the Washington Redskins in 2006-2017 season before going on to play in the Canadian Football League between 2009 and 20011;
- Tamarick Vanover, a former NFL wide receiver the Kanas City Chiefs, San Diego Chargers and Las Vegas Posse who was the Atlantic Coast Conference Rookie of the Year while playing for Florida State in 1992; and
- Carlos Rogers, a former NFL cornerback drafted by the Washington Redskins, who also played for the San Francisco 49ers and Oakland Raiders;
- Charges of one count of conspiracy to commit wire fraud and health care fraud, one count of wire fraud and one count of health care fraud against:
- Clinton Portis, a former NFL running back best known for his years as a starting running back for the Washington Redskins, for seven seasons, who also played with the Denver Broncos during his 10 year NFL career;
- Ceandris “C.C.” Brown, a former safety drafted by the Houston Texans in 2005 who after three seasons with Houston was signed by the New York Giants, Detroit Lions and Jacksonville Jaguars;;
- James Butler, a former NFL safety for the New York Giants from 2005-2008 Seasons and with the St. Louis Rams from 2009-2012; and
- Fredrick Bennett, a grid iron defensive back drafted by the Houston Texans in 2007 before being traded to the San Diego Chargers in 2010, the Cincinnati Bengals in 2010, and the Arizona Cardinals in 2011 before going on to play in the Canadian Football League from 2012 to 2016. Bennett is currently a NFL free agent; and
- Charges of one count of conspiracy to commit wire fraud and health care fraud against:
- Correll Buckhalter, a former NFL running back who played with the Philadelphia Eagles from 2001 to 2008 and the Denver Broncos from 2009 to 2010;
- Etric Pruitt, a former NFL special teams and safety who after having little playing time for most of his NFL career played a major role in Super Bowl XII while signed to the Seattle Seahawks. In addition to his Seahawks stink in 2005, Pruitt also was signed with the Atlanta Falcons and Detroit Lions during his NFL career.
In addition to the charges brought Thursday, the Justice Department also has filed notice that it intends to file criminal charges alleging conspiracy to commit health care fraud in the Eastern District of Kentucky against the following individuals:
- Joseph “Joe” Horn, a former NFL wide receiver who played with the Kansas City Chiefs, New Orleans Saints, and Atlanta Falcons between 1996 and 2007. Horn made the Pro Bowl team four times and is a member of the New Orleans Saints Hall of Fame. In 2001, Horn made headlines when he and 11 other former NFL plays sued the NFL alleging it failed to properly diagnose and treat head injuries that led to changes in the NFL policies regarding diagnosis and treatment of players for potential brain injuries and the establishment of a traumatic brain injury fund; ;and
- Donald “Reche” Caldwell a former NFL wide receiver who during his six seasons in the NFL played with the Sand Diego Chargers, New England Patriots, Washington Redskins and St. Louis Rams.
According to allegations in the indictments, McCune, Eubanks, Vanover, Buckhalter, Rogers and others recruited other players into the scheme by offering to submit or cause the submission of these false and fraudulent claims in exchange for kickbacks and bribes that ranged from a few thousand dollars to $10,000 or more per claim submitted. As part of the scheme, the defendants allegedly fabricated supporting documentation for the claims, including invoices, prescriptions and letters of medical necessity. After the claims were submitted, McCune and Buckhalter allegedly called the telephone number provided by the Plan and impersonated certain other players in order to check on the status of the false and fraudulent claims.
The indictments reflect the Justice Department’s continuing commitment to investigate and prosecute health care fraud, including fraudulent dealings by plan members and others.of private employeer or union sponsored health plans. If convicted, the defendants could face significant prison sentences and probation and fines.
The Justice Department press release concerning the indictments quotes U.S. Attorney for the Eastern District of Kentucky Robert M. Duncan Jr.,the Justice Department has “prioritized the investigation and prosecution of health care fraud in our office.” Meanwhile, FBI Special Agent in Charge of the Miami Field Office George L. Piro is quoted as stating that “This investigation serves as an illustration of the rampant and deliberate scams against health care plans occurring daily throughout the country…” in this case, these fraudsters pocketed money from the Gene Upshaw National Football League Health Reimbursement Account Plan that was intended for former NFL players who are ill or infirm. Over 20 FBI field offices participated in this investigation which demonstrates the level of commitment we have to rooting out this type of fraud.”
In addition to the additional costs that employers can incur to fund health plan liabilities, taking prudent steps to detect, prevent and redress fraudulent health plan claims is considered part of the fiduciary duies of heatlh plan fiduciaries under the Employee Retirement Income Security Act. Fiduciaries found to have failed to take such prudent actions risk personal liability fo rplan losses resulting from fraud committed against their health plans.
The NFL player indictments show taht prosecutions Alone or coupled with the hundreds of other fraud investigations and prosecuations that the Department of Justice and other federal and state agencies pursue each year, send a strong message that the Justice Department and other fedederal agencies stand ready to investigate nad prosecute health care fraud against private employer or union sponsored health plans, as well as fraud against Medicare, Mdicaid and other government programs.
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About the Author
Recognized by her peers as a Martindale-Hubble “AV-Preeminent” (Top 1%) and “Top Rated Lawyer” with special recognition LexisNexis® Martindale-Hubbell® as “LEGAL LEADER™ Texas Top Rated Lawyer” in Health Care Law and Labor and Employment Law; as among the “Best Lawyers In Dallas” for her work in the fields of “Labor & Employment,” “Tax: ERISA & Employee Benefits,” “Health Care” and “Business and Commercial Law” by D Magazine, Cynthia Marcotte Stamer is a practicing attorney board certified in labor and employment law by the Texas Board of Legal Specialization and management consultant, author, public policy advocate and lecturer widely known for 30+ years of health industry and other management work, public policy leadership and advocacy, coaching, teachings, and publications.
A Fellow in the American College of Employee Benefit Counsel, as a primary focus of this work, Ms. Stamer has worked extensively with employer and union sponsored health and other employee benefit plans, insurers, third party administrators, plan fiduciaries and other health and other insured and self insured employee benefit industry clients, employers and other plan sponsors, domestic and international hospitals, health care systems, clinics, skilled nursing, long term care, rehabilitation and other health care providers and facilities; medical staff, accreditation, peer review and quality committees and organizations; billing, utilization management, management services organizations, group purchasing organizations; pharmaceutical, pharmacy, and prescription benefit management and organizations; consultants; investors; technology, billing and reimbursement and other services and product vendors; products and solutions consultants and developers; investors; managed care organizations, health industry advocacy and other service providers and groups and other health industry clients as well as federal and state legislative, regulatory, investigatory and enforcement bodies and agencies.
Scribe for the ABA JCEB Annual Agency Meeting with OCR, Vice Chair of the ABA International Section Life Sciences Committee, past Chair of the ABA Health Law Section Managed Care & Insurance Interest Group, the ABA RPTE Employee Benefits & Other Compensation Group and its Welfare Benefits, Fiduciary Responsibiity and other Commitees, Ms. Stamer is noted for her decades-long leading edge work, scholarship and thought leadership on health,care, managed care and insurance, employee benefits, human resources and other workforce and related compliance and internal controls, policy and regulatory affairs, design and operations, and defense including 30 plus years experience working with clients on ERISA, insurance, STARK, antikickback, and other fraud prevention, investigation, defense and enforcement; audits, investigations, and enforcement actions; trade secrets and other intellectual property; crisis preparedness and response; internal, government and third-party licensure, credentialing, accreditation, HCQIA and other peer review and quality reporting, audits, investigations, enforcement and defense; patient relations and care; internal controls and regulatory compliance; payer-provider, provider-provider, vendor, patient, governmental and community relations; facilities, practice, products and other sales, mergers, acquisitions and other business and commercial transactions; government procurement and contracting; grants; tax-exemption and not-for-profit; privacy and data security; training; risk and change management; regulatory affairs and public policy; process, product and service improvement, development and innovation, and other legal and operational compliance and risk management, government and regulatory affairs and operations concerns. to establish, administer and defend workforce and staffing, quality, and other compliance, risk management and operational practices, policies and actions; comply with requirements; investigate and respond to Department of Justice, Department of Labor, Department of Health and Human Services, Department of Insurane, Board of Medicine, Health, Nursing, Pharmacy, Chiropractic, and other licensing agencies, Department of Aging & Disability, FDA, Drug Enforcement Agency, OCR state attorneys’ general and other federal and state agencies; JCHO and other accreditation and quality organizations; private litigation and other federal and state health care industry actions: regulatory and public policy advocacy; training and discipline; enforcement; and other strategic and operational concerns.
Author of a multitude of highly regarded publications and programs on health and managed care fraud,and other health care, health plan and other health benefit, health care, employee benefits and other related matters, the American Bar Association (ABA) International Section Life Sciences Committee Vice Chair, a Scribe for the ABA Joint Committee on Employee Benefits (JCEB) Annual OCR Agency Meeting and a former Council Representative, Past Chair of the ABA Managed Care & Insurance Interest Group, former Vice President and Executive Director of the North Texas Health Care Compliance Professionals Association, past Board President of Richardson Development Center (now Warren Center) for Children Early Childhood Intervention Agency, past North Texas United Way Long Range Planning Committee Member, and past Board Member and Compliance Chair of the National Kidney Foundation of North Texas, and a Fellow in the American College of Employee Benefit Counsel, the American Bar Foundation and the Texas Bar Foundation, Ms. Stamer also shares her extensive publications and thought leadership as well as leadership involvement in a broad range of other professional and civic organizations. For more information about Ms. Stamer or her health industry and other experience and involvements, see here or contact Ms. Stamer via telephone at (214) 452-8297 or via e-mail here.
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