The Eastern District of Kentucky has charged ten former National Football League (NFL) players, including former Washington Redskins running back, Clinton Portis, for their alleged involvement in defrauding a health care benefit program for retired NFL players to the tune of over $3.4 million.

Targeting the Gene Upshaw NFL Player Health Reimbursement Account Plan, the footballers had allegedly submitted fraudulent claims, amounting to over $3.9 million, and pocketed nearly $3.4 million from the payout between June 2017 and December 2018.

Commenting on the indictment, Assistant Attorney General Brian A. Benczkowski said in a statement, "Ten former NFL players allegedly committed a brazen, multi-million-dollar fraud on a health care plan meant to help their former teammates and other retired players pay legitimate, out-of-pocket medical expenses."

Clinton Portis
Clinton Portis Wikimedia Commons

What is 'the Plan'?

The Gene Upshaw NFL Player Health Reimbursement Account Plan, or simply known as 'the Plan', is an $800 million plan funded by the NFL and established in 2006 under a collective bargaining agreement to benefit retired players. It aids in the tax-free reimbursement of out-of-pocket medical expenses that are not covered by insurance, which are incurred by former players, their spouses, and their dependents.

Players who qualify for the program may receive up to $350,000 in tax-free reimbursements for themselves or their families. A seven-member board consisting of representatives appointed by the NFL administers the Plan, while the health service company, Cigna, serves as its benefits administrator. The Plan also enables the treatment of players suffering from cognitive and neurological diseases such as Parkinson's and Alzheimer's.

How the scheme played out

The indicted players would allegedly submit phony claims to the Plan for expensive medical equipment. Often, the value of every claim would be between $40,000 and $50,000, and the equipment that were never prescribed by any doctor, would never be purchased or received. Some of the claims for costly medical equipment included cryotherapy machines, hyperbaric oxygen chambers, ultrasound machines for the examination of women's health and electromagnetic therapy devices meant for horses.

The allegations in the indictment state that some of the players, that the prosecution calls the 'ringleaders', brought other eligible players on board by offering to submit or help them in the submission of phony claims. They would, in turn, receive bribes and kickbacks that could be as high as $10,000 or above for every submitted claim. The 'ringleaders' would allegedly impersonate other players and call the number provided by the Plan to seek updates on the submitted fraudulent claims.

In order to deceive the benefits administrator, Cigna, the players allegedly presented fabricated or phony paperwork to corroborate the false claims made. This included alleged forging of signatures of certified doctors and fake records from health care providers.

Correll Buckhalter
Correll Buckhalter                                      Wikimedia Commons

Who are the indicted players?

The list of indicted includes former players from various teams. They are Robert McCune (40), John Eubanks (36), Tamarick Vanover (45), Carlos Rogers (38), Clinton Portis, (38), Ceandris Brown (36), James Butler (37), Fredrick Bennett (35), Correll Buckhalter (41), and Etric Pruitt (38).

"The defendants are alleged to have developed and executed a fraudulent scheme to undermine a health care benefit plan established by the NFL – one established to help their former teammates and colleagues pay for legitimate medical expenses," said US Attorney Robert M. Duncan Jr., Eastern District of Kentucky.

The indictment

Two grand jury indictments have been filed in the Eastern District of Kentucky, outlining two alleged conspiracies involving different players but related to the same scheme aimed at defrauding the Plan.

McCune is charged with one count of conspiracy to commit wire fraud and health care fraud, and nine counts each for health care fraud and wire fraud. Eubanks, Vanover, and Rogers are each charged with one count of conspiracy to commit health care fraud and wire fraud, two counts of health care fraud and two counts of wire fraud. Portis, Brown, Butler, and Bennett are each charged with one count of conspiracy to commit health care fraud and wire fraud, one count of health care fraud and one count of wire fraud.

Carlos Rogers
Carlos Rogers Wikimedia Commons

Six of the indicted players agreed to surrender to federal authorities. The four who refused to surrender have been arrested.

In addition to the ten players, the government has filed a notice that it intends to file criminal charges against Joseph Horn (47) and Donald 'Reche' Caldwell (40) with conspiracy to commit health care fraud.

Disservice to deserving colleagues

Highlighting the risk at which deserving former players were put at by the alleged conspirators, Benczkowski said at a conference: "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."

George L. Piro, FBI Special Agent in Charge, Miami Field Office, said over 20 field offices were a part of the investigations. Highlighting the increasing trend of health care fraud across the nation, he commented, "This investigation serves as an illustration of the rampant and deliberate scams against health care plans occurring daily throughout the country."