The federal government recently accused an orthopedic surgeon from Texas of False Claims Act violations. The health care fraud crimes the physician face allegedly included illegal kickbacks. More specifically, the Department of Justice (DOJ) accused the specialist of taking payouts from OK Compounding in exchange for prescribing on of their medications for a span of approximately two years.
Part of a bigger investigation
The allegations were part of the DOJ’s larger investigation into the practices of OK Compounding. Thus far, the agency’s case has been successful. This was the government’s twelfth kickback settlement in connection to its investigation of the company.
The DOJ, along with the Defense Criminal Investigative Service, IRS-Criminal Investigation Division, Department of Veterans Affairs and other federal agencies, have dug into the company’s methods of encouraging physicians to prescribe pain creams. The DOJ has accused the company of paying doctors in exchange for prescribing high levels of the topical medication.
The physician in question in this case billed Medicare, TRICARE, the Veterans Health Administration as well as other federal insurance programs for use of the prescription cream. Because he billed federal insurance programs, the DOJ could build a claim stating the physician violated the False Claims Act. In order to find success, the government would need to argue the physician’s decision for prescribing the medication were financially, instead of medically, motivated.
When faced with the evidence, the physician chose to accept a plea deal. According to the agreement, the physician has not admitted liability but has agreed to pay the government $300,000 in restitution. Additional civil claims are moving forward.