Tampa Pharmacy Charged With Overbilling Military Health Program

Civil complaint says cost of prescription pain creams was as much as 100 times higher than that charged those paying cash

A pharmacy in Tampa, Fla., defrauded a military health-care program by charging prices for prescription pain creams that were as much as 100 times higher than what the pharmacy charged those paying cash, the Justice Department alleged in a civil complaint filed in federal court.

The allegations are the latest effort by federal prosecutors to recoup billions of dollars paid by Tricare, the health insurance program for military service members, for pain creams and gels as a result of alleged fraud by compounding pharmacies in recent years.

RS Compounding LLC charged as much as $4,400 for a popular pain cream when it was purchased by a Tricare beneficiary, but charged just $45 for the same product when it was bought by someone without insurance, according to a civil complaint filed Friday in federal court in Tampa by the U.S. attorney’s office for the Middle District of Florida. The pharmacy’s owner, Renier Gobea, is also named as a defendant in the complaint.

“Mr. Gobea denies the allegations,” said his attorney, Kevin J. Darken.

By charging Tricare much higher prices, the pharmacy violated federal regulations that prohibit vendors from charging prices in excess of what they charge the general public, prosecutors claim.

“RS Compounding knowingly and routinely charged artificially inflated prices for its creams and gels” from 2012 to 2014, the complaint says. As a result, the U.S. “suffered damages in the form of millions of dollars in unearned Tricare payments” made to the pharmacy, the complaint says. read more »

Moody’s: DOJ investigation into Booz Allen 'could take years to resolve’

While McLean-based government technology firm Booz Allen Hamilton Inc. (NYSE: BAH) hasn’t released many details about a recent Department of Justice probe launched against the company for potential cost accounting malpractice, one analyst firm says the matter "could take years to resolve.”

New York-based credit analyst firm Moody’s Investors Service Inc. pointed out in a report last week that while "it is not fully clear from the disclosures thus far” what exactly the feds are investigating, Moody’s suspects that it is a possible violation of the False Claims Act. This occurs when a contractor falsifies invoices to inflate costs charged to the government. read more »

The Briefcase: Carolinas HealthCare pays $6.5 M to settle federal lawsuit

• Carolinas HealthCare System agreed Friday to pay $6.5 million to settle a federal lawsuit that the company violated the False Claims Act by “up-coding” claims for urine drug tests in order to receive higher payment than allowed for the tests.

Also participating in the legal action were Josh Stein, North Carolina’s attorney general, and the U.S. Department of Health and Human Services.

According to court documents, from 2011 to 2015, the health-care system conducted urine drug tests, categorized as “moderate complexity” tests by the Food and Drug Administration. However, it submitted claims that indicated the company had conducted “high complexity” tests.

Claims submitted to federal health care programs include a code that identifies the services provided and that triggers a certain payment, typically at least $100 for the high complexity test compared with the $20 cost for the moderate complexity one.

The allegations arose from a lawsuit filed by a whistleblower, Mark McGuire, a former laboratory director for Carolinas. McGuire will receive $1.36 million from the settlement. read more »

Does "Meaningful Use" Mean Widespread Abuse? - HHS-OIG's Review of EHR Incentive Payments

In 2009, as part of the HITECH Act, the federal government funded an incentive program by which health care providers who implemented and used electronic health records (“EHRs”) for their patients were able to receive significant financial benefits.  The incentive program, which provided for potentially substantial payments to medical providers who engage in the “meaningful use” of EHRs, was premised on the view that the jettisoning of paper records, and the adoption and use of electronic medical records, was likely to improve the quality of patient care, improve patient safety, and reduce health care costs.  But, from the very outset, entities such as the Government Accountability Office also made note of a darker side to the incentive program – namely, the potential that the program would be subject to fraud and abuse, and the need for significant oversight to ensure the integrity of payments made under the program’s auspices.

Given this history, a report that the Office of the Inspector General of the United States Department of Health and Human Services (“HHS-OIG”) released on June 12, 2017 may not be surprising, but its scope is alarming nonetheless. read more »