$10 million settlement in Jacksonville prescription case part of $2 billion fraud probe
She paid a
Tricare, the medical system that provides insurance for active-duty military personnel and retirees and their families, paid
The salve, called a compounded prescription because it was a specialized mix of ingredients, was effective, but Jones said the price bothered her.
"Every time I picked up my prescription I said, 'I'm not wasting my government's money,' " said Jones, whose husband worked for the
She took care to be careful, she said.
"I didn't use nearly as much as it was probably recommended to be used," she said.
Jones' caution was unlike what the federal government saw in the prescription compounding industry that led investigators to an estimated
Since March the
In September Jacksonville's
Together the five agreed to pay about
Of
The cream Jones bought from
Across the country compounding pharmacies were charging as much as
The cost to actually compound these creams was often only about 5 percent of the submitted cost, according to the
Of the
Tricare, a government agency, was seen as more likely to pay than other insurers, but honing in on military families also said something else.
It was greedy, Mehta said.
"They are living the best lives in
"Why they need to take advantage of a health-care program designed for military personnel is beyond me," he said.
Investigations are taking place in other states, Mehta said. In
So far
Mehta, who investigates health-care fraud, said Tricare noticed huge increases in compounded prescription costs about the same time that month-to-month data analysis by the
"The spike was particularly acute in
He said the office decided to investigate 20 pharmacies in
On the Friday afternoon before
Since 2013 there had been astronomical growth in the volume of prescriptions sent to Tricare from the
"What we saw in a lot of these pharmacies is that one or two, or in this case four, doctors would make up a vast majority of the prescriptions," he said. "And that raised alarm bells for us."
According to the
Tricare went to
The agency was on track to lose
The safeguards have resulted in a 98 percent reduction in cost, he said.
FOUNDATIONS OF FRAUD
Proper compound prescriptions are effective and often designed for people who cannot take pills or perhaps have unwanted reactions to conventional medications. Bansal enlisted three colleagues to join in the company, which they planned to use to produce the compounds.
Nelson said the doctors, pain-management physician
"As physicians, we have always acted in the best interests of our patients," the statement said. "In every instance we prescribed medication in good faith; the topical compounded pain creams at issue in this matter are an effective alternative to narcotic medications, which can have serious side effects.
"When we were recruited to invest in a pharmacy to fill our prescription orders," the statement continued, "we consulted legal counsel and trusted our partners who assured us that the business was acting strictly in compliance with the law. Our trust was misplaced. We fully and willingly cooperated with the government's investigation and look forward to putting this regrettable business decision behind us."
Mehta said the government realizes some individuals were more culpable than others, but there were signals that should have been alarms. Civil actions such as the ones the government took in the cases so far can be based on reckless behavior.
"They started getting hundreds of thousands of dollars in checks but didn't ask any questions," he said.
The Justice Depatment said the four wrote hundreds of prescriptions, recruited other doctors and
Attorney
"The settlement agreement speaks for itself," he said.
A call to an attorney representing Patel was not returned.
TARGETED PATIENTS
Mehta said several thousand people in the
In order to recruit patients some companies -- although
Those marketers would find doctors willing to write prescriptions through the compounding pharmacy the marketers worked for. Mehta said some doctors were paid. Patients also were sometimes paid and told they would be participating in a study.
Payments are often considered kickbacks, which are illegal, he said.
"That spotlight will be intensifying," he said."
Mehta said in interviews with patients, investigators found many were baffled by what they were receiving.
"It's being pitched as these miracle creams," he said. "We have not talked to many patients who said it worked. Ninety-eight percent tell us 'I didn't use it, I didn't want it, it didn't work."
He said while the prescriptions are intended to be tailored to an individual with specific needs, that was not being done. Instead, some were making a stock supply of 10 or so mixtures that were sent to different patients.
Jones, the Tricare pharmacy chief, said the 9 million beneficiaries in the program made a soft target. Part of Tricare's role he said made it more open than other insurance programs.
"A very strong interest is assuring our folks have good pain management," he said.
That too became a target of unscrupulous companies.
"They preyed on that population," Jones said.
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