The United States Department of Justice (DOJ) recently accused a general surgeon out of Texas of partaking in a scheme to defraud government insurance agencies. According to the allegations, the physician is one of three doctors and 13 others allegedly responsible for over $39.7 million paid out in fraudulent claims.
The DOJ has accused the medical professional of taking kickback payments to refer patients to a healthcare agency that played a key role in the scheme. The general surgeon will need to build a defense against allegations that include three counts of health care fraud. The government has also accused the physician of conspiracy to defraud the government and conspiracy to commit health care and wire fraud.
DOJ cracks down on fraud using claims for compounded medications
The allegations involve fraudulent prescriptions for compounded medicines. A pharmacist makes a compounded medication through a combination or alteration of commercial drugs to meet the specific needs of an individual patient. They are, essentially, a drug tailored to each individual patient.
The government is taking allegations of fraud connected to the use of compounded medications very seriously. The medications used to make these tailored products are costly, making them particularly susceptible to fraudulent practices. One type of pain-relief cream that was used in this case to perpetrate the alleged fraud against the government can cost over $15,000 for 15 ounces. Government insurance agencies report paying $2 million for compounding drugs in 2011. The requests have skyrocketed in recent years and the government reports over $263 million in claims for 2016.