Tuesday, December 20, 2016

Florida Man Indicted for Receiving $20 Million in Marketing Fees From Compounding Pharmacy For Patients Covered by Tricare Health Insurance and Paying Telemedicine Companies to Prescribe Compounded Medication Prescriptions

Compounding pharmacies are facing investigations for marketing arrangements, drug misbranding as well as for health care fraud in billing workers' compensation insurance or Tricare health insurance. A recent case involves billings to Tricare, commission payments and the use of telemedicine in order to have providers issue the prescriptions. 

On December 13, 2016, Monty Ray Grow of Tampa, Florida was charged by Indictment which alleges that between September 2014 and June 2015, Mr. Grow received approximately $20 million in payments from a Broward County, Florida compounding pharmacy in exchange for recruiting and referring patients that were covered by the Tricare health care insurance program. The government alleges that these payments were "kickbacks." An Indictment is merely an accusation and every defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.

The Indictment further alleges that Mr. Grow and others defrauded Tricare by paying telemedicine companies to provide compounded medication prescriptions to the recruited patients without conducting any physical examination of the patients as required by law. It is also alleged that these invalid prescriptions were issued without regard to the patients’ medical necessity.  The Indictment further alleges that Mr. Grow used the proeeds to buy real estate, luxury vehicles and securities.    

The time period here was key for Tricare which was to adopt new controls on compounded medication prescriptions in May 2015. The year before there was aggressive marketing of military families who were cold called about compounded medications. In 2004 Tricare paid $5 million for compounded medications but in the fist 3 months of 2015 alone, Tricare was billed at least $700 million. This is by all providers and it shows part of the reason Tricare became aggressive about compounding. The marketing of compounding medications directly to patients was aggressive across the country and this case is the first of more to come against compounding pharmacies, physicians and marketers.

Mr. Grow was charged with:
(1) conspiracy to defraud the United States and to pay and receive health care kickbacks, in violation of Title 18, United States Code, Section 371; 
(2) health care fraud, in violation of Title 18, United States Code, Section 1347; 
(3) receipt of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a-7b(b)(1)(A); 
(4) payment of kickbacks in connection with a federal health care program, in violation of Title 42, United States Code, Section 1320a-7b(b)(2)(B); 
(5) money laundering, in violation of Title 18, United States Code, Section 1957; and
(6) causing the misbranding of drugs while held for sale, in violation of Title 21, United States Code, Sections 331(k) and 331(a)(1).

This will be an extensive case and is expected to result in additional charges across the rest of the country. 

Posted by Tracy Green, Esq.
Email: tgreen@greenassoc.com
Phone: 213-233-2260
Green and Associates, Attorneys at Law


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