Business ProfileforHealthRight, LLC

In February 2018 it came to BBB's attention that HealthRight, LLC has received a pattern of consumer complaints concerning Billing Issues and Sales Practice Issues.

Specifically, consumers complaints allege they have received multiple phone calls in regards to clinical trials on chronic pain issues. Consumers further allege they are pressured to give personal information over the phone, such as insurance and date of birth, for a phone consultation with a licensed medical professional. After giving the requested information, consumers allege the business prescribed and billed insurance for medication they did not authorize.

BBB has contacted the business to obtain their position, to date there has been no reply.

The following describes a pending government action that has been formally brought by a government agency but has not yet been resolved. We are providing a summary of the government's allegations, which have not yet been proven.

Tennessee: On September 14, 2018, United States of America and the United State Attorney for the Eastern District of Tennessee, brought an action against Scott G. Roix and HEALTHRIGHT, LLC. and other businesses for alleged violations of Conspiracy to Commit Health Care Fraud and Conspiracy to Commit Wire Fraud. Mr. Roix has plead guilty to felony conspiracy in the telemedicine health care fraud and also pleaded guilty to conspiring to commit wire fraud for fraudulently telemarketing dietary supplements, skin creams, and testosterone. Mr. Roix faces a statutory maximum sentence of 5 years of imprisonment for each conspiracy. The Court set sentencing for August 2022.
For more information regarding this case please contact The United States Department of Justice at https://www.justice.gov or number 202-353-1555.
(Case No. 2:18-CR133, U.S District Court Eastern District of Tennessee at Greeneville).
Tennessee alleges, in part: From on or about June 1,2015 through on or about April 1,2018, Mr. Roix and HEALTHRIGHT LLC knowingly and willfully conspired with a number of Pharmacy's
to deceive tens of thousands of patients and more than 100 doctors located in the Eastern District of Tennessee and elsewhere for the purpose of executing a scheme and artifice to defraud health care benefit programs out of more than approximately $100,000,000 and, in furtherance thereof, caused to be submitted not less than approximately $505,000,000 in fraudulent claims for payment.

From on or about July 1,2017 through August 1,2018, Mr. Roix and HEALTHRIGHT also knowingly and willfully conspired with others to fraudulently market and sell consumer products such as weight-loss pills, skin creams, and testosterone supplements to thousands of consumers located in the Eastern District of Tennessee and elsewhere for the purpose of executing a scheme and artifice to defraud those consumers out of more than $3.7 million.


COUNT ONE:
Conspiracy to Commit Health Care Fraud.

HEALTHRIGHT, did knowingly, intentionally, and unlawfully combine, conspire, confederate, and agree with the Pharmacy's and other persons and entities to commit certain offenses against the United States, that is: healthcare fraud - did knowingly and willfully execute a scheme and artifice to defraud health care benefit programs Medicare, TRICARE, Medicaid, FECA, FEHBP, and the Private Carriers, and to obtain, by means of materially false and fraudulent pretenses, representations, and promises, money owned by and under the custody and control of Medicare, TRICARE, Medicaid, FECA, FEHBP, and the Private Carriers, in connection with the delivery of and payment for health care benefits and services.

It was part of the conspiracy that Mr. Roix and HEALTHRIGHT formulated a plan and agreement that, among other things, included the following:

Prescription Brokering
Inflated Average Wholesale Price ("AWP") Medications HeaIthRight's Care Platform.

Mr. Roix deployed HEALTHRIGHT's care platform to obtain doctor authorized
prescriptions for the highly-profitable Inflated AWP Medications, as agreed with the
Pharmacy Principals.

The care platform consisted of three parts:
First, the call center staff obtained each patient's insurance information ("phase I");

Second, a HEALTHRIGHT employee masquerading as a licensed, trained, and practicing medical professional documented pro forma each patient's medical history and then HEALTHRIGHT's care platform selected Inflated AWP Medications to be prescribed for the patient as well as the pharmacy to fill them ("phase II");

Third, HEALTHRIGHT emailed or texted a doctor licensed in the patient's state and informed the doctor that an "e-consult" was ready for online review; deceived the doctor to believe that a licensed, trained, and practicing medical professional had reviewed the patient's medical history and used her medical training to prepare patient's medical notes, which were then presented to the doctor; and deceived the doctor to believe that the patient had requested a prescription for a specific Inflated A WP Medication by name - the doctor could then select that exact Inflated AWP Medication from a drop-down menu pre-populated into HEALTHRIGHT's care platform, as per HEALTHRIGHT's agreement with the Pharmacy's ("phase III").

In phase I, to obtain prescriptions to sell to the Pharmacy's, Mr. Roix and HEALTHRIGHT deceived patients into providing their health insurance information and accepting Inflated AWP Medications. To accomplish this, Mr. Roix and HEALTHRIGHT employed some or all of the following techniques:

Placed false advertisements on various websites and social media outlets including, without limitation, Facebook and Yahoo!, indicating that HEALTHRIGHT offered clinical research trials utilizing cannabidiol oil or CBD oil or other cannabis related medications;

Placed false advertisements on various websites and social media outlets including, without limitation, Facebook and Yahoo!, indicating that HEALTHRIGHT offered clinical stem cell research trials;

Falsely informed patients that they would be notified of the amount of any copay, and have the opportunity to cancel their orders, before medications were mailed to them;

Falsely informed patients that they would receive the medications as part of a free trial program;

Falsely informed patients that they were not required to pay their copays; (f) falsely informed patients that the Inflated A WP Medications were very effective at treating various ailments;

Deceived patients about the specific Inflated A WP Medications that would be shipped to them;

Intentionally withheld from patients the price of Inflated A WP Medications;

Intentionally withheld from patients that the S-Pharmacy Principals and Conspirator #4 were paying HEAL THRIGHT for each prescription;

Employed intentionally vague and misleading call scripts to induce patients to say "yes" to certain recorded questions asked in furtherance of the conspiracy;

Ignored patient requests to discuss prescriptions with the pharmacy or doctor prior to dispensing.

Also, in phase I, Mr. Roix and HEALTHRIGHT automatically disqualified patients who did not have health insurance because the Pharmacy's knew they would be unable to sell any Inflated AWP Medications to patients for cash. Once the phase I caller confirmed that the patient had insurance, the phase I caller would automatically waive HEALTHRIGHT's standard patient consultation fee of approximately $55 for every patient contacted by HEALTHRIGHT about Inflated AWP Medications. They did this because Mr. Roix and HEAL THRIGHT knew that the patients would not provide insurance information to HEALTHRIGHT if they were required to pay any fee to HEALTHRIGHT.

Through this process, Mr. Roix and HEAL THRIGHT created artificial demand for Inflated
AWP Medications.

In phase II, Mr. Roix and HEALTHRIGHT deceived patients into believing
that they were speaking with nurses or other trained clinical staff who were engaged in the
practice of medicine.

In phase III, after obtaining patient authorization using the misleading methods
described above in phases I and II, Mr. Roix and HEALTHRIGHT deceived doctors to
authorize medically unnecessary prescriptions for Inflated AWP Medications to patients. To
accomplish this, Mr. Roix and HEALTHRIGHT:

Falsely led doctors to believe that nurses were triaging patients before patient information was conveyed to doctors;

Falsely led doctors to believe that patients had requested specific Inflated AWP Medications by name or that patients had requested medications for supplemental therapies for scars, headaches, or general wellness;

Intentionally concealed from doctor's information that was material to their decisions to authorize prescriptions for Inflated AWP Medications including, without limitation, the prices that the PBMs would be billed for such Inflated AWP Medications;

Intentionally concealed from doctors that the Pharmacy's paid HEALTHRIGHT on a per-prescription basis or split revenue with HEALTH RIGHT for each billed prescription authorized by those doctors;

Intentionally concealed from participating doctors the fact that many patients had stated that the Inflated AWP Medications were ineffective at treating patient ailments;

Instructed HEALTHRIGHT staff to assign "patient encounters" to those doctors who were most likely to authorize prescriptions, as determined by historical performance data within HEALTHRIGHT's possession and without regard to patients' medical needs;

Designed the care platform in a manner that channeled participating doctors to select Inflated AWP Medications from a drop-down menu that was pre-populated with a list consisting only of medications pre-selected by the Pharmacy's;

Falsely led doctors to believe that patients had requested 3 automatic refills for prescriptions for Inflated AWP Medications.

Mr. Roix and HEALTHRIGHT induced doctors to authorize the substitution cascade by leading them to believe that by doing so they were authorizing the substitution of therapeutically-equivalent generic drugs for the prescribed Inflated AWP Medication; whereas,
in fact, the doctors were authorizing the pharmacies to "phish" or "test bill" until they found the most profitable drug covered by each patient's insurance. Mr. Roix and HEALTHRIGHT
never disabused the doctors of this misconception.

During the conspiracy, Mr. Roix caused HEALTHRIGHT to design and
deploy numerous advertising campaigns intended to deceive thousands of patients into providing their insurance information to HEALTHRIGHT, including without limitation advertisements on Facebook and Yahoo! that deceived patients to believe that HEALTHRIGHT would enroll them in clinical stem cell research trials or clinical cannabis oil trials or would provide them with cannabis-based medications.

During the conspiracy, Mr. Roix caused HEALTHRIGHT call center staff to
deceive thousands of patients about the nature, cost, and efficacy of the medications they would receive, the financial relationship between HEALTHRIGHT and the Pharmacy's, and the reason that HEALTHRIGHT needed the patients' insurance information.

Between June 1,2015 and April 1, 2018, Mr. Roix, HEALTHRIGHT, the Pharmacy's, and other persons and entities caused the PBMs to pay them not less than approximately $100,000,000 for Inflated A WP Medication prescriptions obtained pursuant to the scheme to defraud described herein.

This amount also consisted of at least approximately $1,027,975 obtained
from Medicare for fraudulent claims, at least approximately $426,929 obtained from TRICARE
for fraudulent claims, at least approximately $1,020,161 obtained from various state Medicaid
programs for fraudulent claims, approximately $828,297 from FEHBP, and approximately
$108,582 from FECA.

Between October 15,2015 and November 27,2017, Pharmacy's paid HEALTHRIGHT not less than approximately $31,935,751 in proceeds obtained from the scheme to defraud described herein.

Between December 23, 2016 and December 31, 2017, the Pharmacy's paid
HEALTHRIGHT and Mr. Roix not less than approximately $5,089,471 in proceeds
obtained from the scheme to defraud described herein.

COUNT TWO:
Conspiracy to Commit Wire Fraud.

Beginning on or about July 1,2017 and continuing until on or about August 1,
2018, in the Eastern District of Tennessee and elsewhere, the defendants Mr. Roix and
HEALTHRIGHT, did knowingly, intentionally, and unlawfully combine, conspire, confederate,
and agree with other persons and entities to commit wire fraud against the United States, that is:

The object of the conspiracy was to obtain large sums of money for defendants
Mr. Roix and HEALTHRIGHT, and their co-conspirators, by fraudulently inducing
consumers to pay for consumer products through misrepresentations about

the products themselves
the charges that would be imposed on consumers' credit cards
HEALTHRIGHT's willingness to cancel payments and provide refunds

As part of HEALTH RIGHT's telemarketing operations, Mr. Roix and his
co-conspirators knowingly and willfully devised call scripts that were designed to deceive
consumers, in that the call scripts contained claims that were materially false, misleading, and
omitted material information that induced consumers to allow credit card charges to
HEALTHRIGHT, for the financial benefit of HEAL THRIGHT, Mr. Roix, and his coconspirators.
HEALTHRIGHT's telemarketers made numerous false and deceptive claims to
consumers about a variety of consumer products they sold.

For example, pursuant to the above-described call scripts, HEALTHRIGHT's
telemarketers falsely claimed that a product called "Pure Garcinia Cambogia" would "prevent
fat from being made" and "increase serotonin levels which helps you feel fuller longer, helps
maintain healthy stress hormone cortisol that can decrease belly and thigh fat and most
importantly it's all natural and stimulant free weight loss with no known side effects."

In addition, pursuant to the above-described call scripts, HEALTHRIGHT's
telemarketers falsely claimed that a product called "SkinTensive Xcel" "uses a clinically proven
formula that features acetyl hexapeptide 8, a material that mimics the effect on deep wrinkles of Botox."

Mr. Roix and others under his direction trained HEALTHRIGHT's telemarketers to dissuade consumers from doing independent research on the products for fear they would discover these false claims in the call scripts. When consumers told HEALTHRIGHT's telemarketers that they wanted to conduct further research, HEALTHRIGHT's telemarketers falsely told consumers "I am the best resource for your research. I can give you more information and more specific responses to the questions you need answered than a website."

HEALTHRIGHT's sales scripts for many of its products lured consumers into
purchasing products, falsely assuring consumers that HEALTHRIGHT's offers were risk-free
and promising excellent customer service.

To induce initial sales of consumer products, HEALTHRIGHT's telemarketers
enrolled consumers in a 14- or 30-day "trial" that was promised to be "risk-free." For consumers to receive their initial shipment of products, HEALTHRIGHT telemarketers told consumers that they needed to provide their credit card information to cover what HEAL THRIGHT' s telemarketers described as only minor "shipping costs" for the initial shipment. Despite this assurance of a "risk-free" trial, HEALTHRIGHT enrolled consumers who accepted an initial shipment of products into a monthly subscription for the product that billed the consumers' credit cards on a monthly basis. HEALTHRIGHT's telemarketers deceptively assured consumers that if, for any reason, they wanted to avoid that monthly charge, they simply needed to call HEALTHRIGHT's customer service department, and upon speaking with representatives in that department, they could easily cancel their subscription and receive a full refund for any products returned unopened.

In fact, HEALTHRIGHT's representations about its customer service were false.
HEALTHRIGHT's customer service was in actuality an arm of its telemarketing operation, and
was designed to delay or otherwise hinder refunds, returns, and cancellations so that
HEALTHRIGHT could charge as many monthly subscription fees as possible. Customers
calling or emailing to cancel recurring monthly charges or demand refunds were not called back, put on hold, or otherwise stalled, and, on the occasions that consumers did speak to someone at HEALTHRIGHT, they were run through a gauntlet of scripted rebuttals that used many similar deceptive or unfounded claims that HEALTHRIGHT used to market the products in the first place, for the sole purpose of delaying the consumers' cancellation as long as possible.

For example, HEALTHRIGHT "customer service" representatives would deceptively convince
consumers demanding cancellations and refunds that
"the product is said to work best over time, and was sold to you at a highly discounted rate"
" offers a full 30-day satisfaction guarantee to give you enough time to try the product and begin to see the results, OK?"

HEALTHRIGHT's telemarketers also concealed HEALTHRIGHT's corporate identity,
identifying themselves as calling on behalf of the brand themselves, for example,
"Hi. This is ____ calling on behalf of Pure Garcinia Cambogia," never providing HEALTHRIGHT's name specifically.

Because HEALTHRIGHT's telemarketers used fraudulent claims to charge the
credit cards of thousands of consumers each month, credit card chargebacks often exceeded
numerical caps set by financial institutions. In order to conceal or otherwise minimize the risk of
chargebacks to HEALTHRIGHT's consumer products telemarketing business, Mr. Roix
and his co-conspirators established a series of corporate entities, each of which was assigned a
separate credit card merchant identification number ("MID") through which HEALTHRIGHT
passed payments and chargebacks. In cases where chargebacks exceeded or risked exceeding a
relevant numerical cap, Mr. Roix and his co-conspirators moved payment settlements from
one MID to another. This diffused the risk that chargebacks in a given time period would reach
or exceed a number that might result in financial institutions halting settlements, prolonging
HEALTHRIGHT's ability to work with financial institutions. This, in turn, enabled its
misrepresentations and charges to consumer credit cards to continue.


On or about October 9, 2017, HEALTHRIGHT sold SkinTensive Xcel to 1.B. of
Roan Mountain, Tennessee, using a script that claimed that the product
"uses a clinically proven formula that features acetyl hexapeptide 8, a material that mimics the effect on deep wrinkles of Botox;"

Mr. Roix, approved the use of a telemarketing sales script that made the claims described above, and provided that script to HEALTHRIGHT's telemarketers who then read that script to consumers during sales calls:

On or about March 14, 2018, Mr. Roix, approved the use of a telemarketing sales script entitled "Straight Sale PGC Script 2014"

On or about May 21, 2018, Mr. Roix, approved the use of a telemarketing sales script entitled "Flawless Youth Skin Care 10.05.15"

On or about May 29,2018, Mr. Roix, approved the use of telemarketing
Sales scripts entitled "Extra Rebuttals"

On or about January 26,2018, HEALTHRIGHT sold Pure Garcinia Cambogia to B. W. of Birchwood, Tennessee, using a script that claimed that the product would
"Prevent fat from being made" and "Increase serotonin levels which helps you feel fuller longer, helps maintain healthy stress hormone cortisol that can decrease belly and thigh fat and most importantly it's all natural and stimulant free weight loss with no known side effects."