Two compounding pharmacies and four physicians have agreed to pay $10 million to settle allegations of false claims submitted to TRICARE, the military’s healthcare program.
The government alleged that one of the compounding pharmacies, Topical Specialists, was created by the four physicians and a pharmacist. The physicians referred their military patients to Tropical Specialists, but it was unable to obtain contracts with government healthcare programs. Topical Specialists then sent its prescriptions to another pharmacy, WELLHealth, which submitted the prescriptions to the federal government.
The government alleged that the physicians steered military patients to Tropical Specialists with hundreds of costly prescriptions for pain and scar creams that may not have been medically necessary. Many of the patients told the government that they never used the creams.
While the pharmacies billed the federal government tens of thousands of dollars for the creams, the actual cost of compounding the creams was only 4-5% of the amount billed to TRICARE. The government alleged that profits of up to 90% were passed on to the four doctors behind Tropical Specialists. The government also alleged that the four doctors recruited other doctors to write prescriptions to be filled by Tropical or WELLHealth, and passed along 40% of the reimbursement to those doctors.
The doctors and the pharmacies settled the government’s fraud claims by agreeing to pay $10 million.
False claims to government healthcare programs are very difficult to detect. For this reason, the government offers substantial rewards to whistleblowers who come forward with evidence of false claims to Medicare, Medicaid, and TRICARE. The whistleblower rewards range from 15% to 30% of the amount to government actually recovers plus attorneys’ fees and costs.
Anyone who has evidence of false claims can become a whistleblower. This includes physicians, medical and billing staff, patients, vendors and competitors.
If you have evidence of false claims submitted to Medicare, Medicaid or TRICARE, then you should consult with an experienced whistleblower attorney immediately to protect your rights. You may be entitled to a significant reward and legal protections.
To arrange a free and confidential consultation with an experienced whistleblower lawyer, call John Howley, Esq. at (212) 601-2728. Whistleblower cases are taken on a contingency fee basis, which means there are no legal fees unless you win.