A Gadsden medical sales representative and a Rainbow City pain clinic owner were sentenced Thursday for their roles in health care fraud conspiracies, U.S. Attorney Prim Escalona announced Friday.
James Ewing Ray, 53, of Gadsden, pleaded guilty to health care fraud conspiracy in February. Ray was a sales representative who marketed numerous health care products and services to doctors’ offices, according to his plea agreement.
From at least 2012 through 2018, Ray conspired to pay and receive kickbacks to cause medical providers to give out medically unnecessary prescriptions and order medically unnecessary goods and services. Those were then billed to Medicare and other health insurers. One service was nerve conduction testing provided by QBR, a Huntsville-based company.
U.S. District Court Judge L. Scott Coogler sentenced Ray to 40 months and ordered him to forfeit more than $850,000 and pay restitution to victims of more than $5.3 million.
David Lyle Shehi, 43, of Rainbow City, pleaded guilty to conspiracy to pay kickbacks and commit health care fraud in 2023. He is sentenced to 28 months and ordered to pay forfeiture and restitution to his victims.
Additionally, Shehi would routinely bill health insurance programs for patient office visits using a code that would generate the highest reimbursement, even though the code was not appropriate. Shehi was warned billing in that way was not allowed.
The FBI and Office of Inspector General for the U.S. Department of Health and Human Services investigated the case.