Compounding pharmacies can be critical bridges between doctors and patients. The pharmacies make drugs prescribed by physicians for patients with very specific needs that can't be met by commercially available prescriptions. A compounding pharmacy custom-makes drugs from two or more medications so that the patient gets exactly what the doctor ordered.
However, the first shoe has dropped in an alleged health care fraud involving compounding pharmacies. A Texas pharmaceutical representative was recently handed a 30-count indictment for her alleged involvement in a $9.5 million overbilling case. More indictments are expected, according to news reports.
Investigators believe they have uncovered a conspiracy revolving around compounding pharmacies that supply pricey medications to military veterans and others.
Federal prosecutors have been investigating claims that some compounding pharmacies and their sales reps were selling pain creams and other drugs to veterans and their families. Investigators say the substances have not been approved by the Food and Drug Administration.
In some cases, the Department of Defense's Tricare insurance and private insurers have been billed $30,000 for a one-month supply of the pain cream, according to a news report.
The recently indicted sales rep is accused of health care fraud, wire fraud and violations of anti-kickback and bribery laws. She is accused of doling out bribes and kickbacks to doctors who, in return, wrote prescriptions for the expensive medications.
She has entered a plea of not guilty.
The Austin, Texas, law firm of Rivas Goldstein LLP represents a wide range of health care professionals who believe they might be under investigation by law enforcement or regulators.