Former Kentucky legislator pleads guilty in case involving $2.7 million in health fraud
A former Kentucky legislator has admitted he knew his pharmacy was submitting improper bills to insurance programs, but didn’t stop the fraud.
Former state Rep. Robert Goforth, 46, pleaded guilty Wednesday in connection with $2.7 million in excess billing.
Goforth 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. The pharmacy multiplied profits by buying a dose of medicine once and then “effectively selling it multiple times,” according to Goforth’s plea document.
“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 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.
Goforth agreed not to appeal any sentence up to three years and one month in prison.
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.
According to Goforth’s plea agreement, a state pharmacy investigator told him in late 2015 about suspected fraud by a pharmacist Goforth had put in charge of Hometown Pharmacy of Manchester, involving prescriptions not being picked up.
The pharmacist, who was not named in court documents, received a percentage of the store’s profits.
Goforth said in court that 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.
His plea agreement said he did nothing more than than having the pharmacist in charge and other employees sign a “self-serving” statement indicating they were not committing fraud and wouldn’t do so.
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, the plea deal said.
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, with various amounts due to Medicare, Medicaid, and private insurance companies.
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.
His running mate that year was Michael Hogan, the longtime county attorney in Lawrence County.
Hogan has also pleaded guilty in federal court this year, admitting he took part in a scheme to overpay his wife, who worked in his office.
The indictment said Hogan and his wife, Joy, conspired to pay her more than $365,000 in bonuses, and that he also over-billed for work to collect child-support payments.
They are scheduled to be sentenced in July.
This story was originally published May 25, 2022 at 4:36 PM.
