FAIRHOPE, Ala. (WKRG) — Two Fairhope pharmacy owners have agreed to pay $1.9 million over allegations that they violated the False Claims Act (FCA) stemming from the payment of illegal kickbacks and the implementation of a refill scheme of medically unnecessary pain creams.
Heritage Compounding Pharmacy, LLC (Heritage), and its pharmacist owners, Christopher and Marti Burgess are at the center of the investigation.
“The U.S. Attorney’s Office is committed to holding health care providers responsible who manipulate and abuse the TRICARE program in order to seek financial gain and who lack regard for TRICARE patients,” said U.S. Attorney Moore.
In a complaint filed on October 29, 2019, the United States alleged that between January 1, 2013 to May 1, 2015, Heritage and its owners submitted false claims to TRICARE, a federally funded health care program for military personnel and their families. The Government alleged that the Defendants, through their “sales representatives”, paid physicians in the form of extravagant dinners and other entertainment perks, to induce prescribing. Heritage employed a sales force to strategically market pre-printed and pre-formulated topical pain cream prescriptions to prescribers in military populated territories such as Kansas City, Southwest Missouri, and Topeka/Manhattan. Many of these creams contained the Schedule III controlled substance Ketamine. Per the complaint, taking advantage of TRICARE’s per ingredient reimbursement policy, without regard to patient need, Heritage implemented a high dose refill scheme costing TRICARE over $27,000.00 per claim for medically unnecessary pain creams prescribed without a valid physician-patient relationship. The local pharmacy shipped large quantities of pre-formulated medication to TRICARE beneficiaries. The U.S. Department of Veterans Affairs (CHAMPVA) also suffered losses from this fraud scheme.
“The Defense Criminal Investigation Service’s will tirelessly pursue unscrupulous companies intent on defrauding and cheating TRICARE, the healthcare system serving our military and veterans. DCIS appreciates the U.S. Attorney’s Office requiring the owners of Heritage Compounding Pharmacy to remunerate TRICARE for prescriptions that were not medically necessary or even utilized by many of the beneficiaries,” stated Special Agent in Charge Cynthia A. Bruce, DCIS, Southeast Field Office.
The investigation and litigation were conducted by the United States Attorney’s Office -SDAL, DCIS and CHAMPVA. The FCA claims settled are allegations only, and there has been no determination of liability.
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