Seven charged in $110 million health care fraud scheme
The OIG was part of a multi-agency investigation that led to indictments against seven people in a $110 million compound drug operation.
Acting U.S. Attorney Jennifer B. Lowery announced the 15-count indictment returned by a federal grand jury in McAllen. The indictment includes charges of conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive illegal kickbacks and conspiracy to commit money laundering.
A compound pharmacy owner, three marketers, a referring physician and two clinic office staff were all taken into custody. The investigation centered on an independent pharmacy that billed various federal health care programs more than $110 million between 2014 and 2016, including claims that were false, fraudulent and the result of illegal kickbacks.
The indictment alleges three of the accused served as marketers for the pharmacy and delivered several million dollars in kickbacks for referring prescriptions for high-reimbursing compound drugs to the pharmacy, including prescriptions that were not medically necessary or what the patients wanted. The Justice Department says the marketers allegedly received kickbacks from the pharmacy owner, which they shared with referring physicians.
Health care fraud and conspiracy to commit health care fraud carry a punishment of up to 10 years in prison and $250,000 fine. The penalty for conspiracy to pay and receive illegal kickbacks is five years with a $25,000 maximum fine. A conviction for conspiracy to commit money laundering can result in up to 20 years in prison and $500,000 in fines.
The Texas Health and Human Services OIG was part of the investigation that included Inspectors General from the U.S. Postal Service, Department of Labor, Veterans Affairs, and U.S. Department of Health and Human Services, along with the FBI, Defense Criminal Investigative Service and the Texas Attorney General Medicaid Fraud Control Unit.
You can read more about the case on the U.S. Department of Justice website. (https://www.justice.gov/usao-sdtx/pr/seven-charged-roles-110-million-compound-drug-scheme)