Insurance
Home›Insurance›Industry & Deals›FBI calls $2 billion telehealth fraud mastermind Sutto…
FBI calls $2 billion telehealth fraud mastermind Sutton “at large” in Russia
Prosecutors say the scheme ran from 2017 to 2022, generated $1.97 billion in fraudulent claims, and insurers paid out $758 million before authorities unwound it.
Brian Sutton, a man federal prosecutors allege ran one of the largest U.S. healthcare fraud operations, is reportedly living in Russia despite being described by the FBI as “at large,” according to Insurance Business. The U.S. Department of Justice says the alleged operation ran from 2017 to 2022 and used call centers in Utah, later relocated to Russia, to cold-call people with private health plans and offer medication at no cost, often without any real medical review. The group allegedly generated prescriptions using the names and national provider numbers of real physicians who did not know a “visit” had taken place, then routed the resulting claims through pharmacies that prosecutors say were controlled through straw owners in states including New York, New Jersey, Pennsylvania, Texas, and Alabama. The DOJ estimates the operation submitted more than $1.97 billion in fraudulent claims and that insurers paid over $758 million before the scheme was unwound. Insurance Business also notes an earlier related California case tied to a separate network of pharmacies, in which 15 defendants pleaded guilty, and reports that Sutton has not been in custody while other federal defendants have pleaded guilty or been convicted, with sentences of up to 10 years and forfeiture orders in the millions.