The U.S. Department of Justice is intervening in a qui tam lawsuit against Patient Care America (PCA), alleging the Florida compounding pharmacy submitted false claims to Tricare. These alleged Tricare false claims sought reimbursement for compound drug prescriptions, which were prescribed to Tricare recipients by doctors under allegedly illegal circumstances.

In return for prescribing these medications to Tricare recipients, PCA allegedly paid these physicians financial kickbacks. This qui tam lawsuit also named pharmacy executives Patrick Smith and Matthew Smith as defendants, along with the private equity firm for being involved in the alleged kickback arrangement in filing the Tricare false claims.

Tricare is a federal healthcare program for members of the United States military and their families. Tricare members were allegedly targeted by PCA and their prescribing physicians, writing out prescriptions for a variety of compounding pharmacy products including pain creams, scar healing creams, and vitamins. However, these products may not have been necessary for the patients’ health, with PCA manipulating the compound formulas to file claims for maximum coverage, the Tricare false claims lawsuit alleges.

This alleged kickback scheme was investigated by the Defense Criminal Investigative Service (DCIS) and the Department of Justice (DOJ), to help protect the government from being defrauded out of tens of millions of dollars in Tricare false claims.

Overview of Qui Tam Lawsuit

According to the qui tam lawsuit, PCA and their representatives had allegedly paid telemedicine doctors to prescribe compound creams and vitamins without even seeing the patients.

In addition, some patients were reportedly paid to accept the prescriptions so PCA could file the Tricare false claims. This kickback scheme allegedly resulted in Patient Care America receiving millions of dollars in Tricare false claims, with defendants and their sales representatives distributing the profits amongst themselves.

However, this alleged scheme was eventually discovered, with the qui tam lawsuit filed by two former PCA employees. Whistleblowers Marisela M. and Ada L. had allegedly discovered the alleged scheme surrounding the Tricare false claims, and filed this Tricare false claims lawsuit.

Marisela and Ada filed the qui tam lawsuit under the False Claims Act, which allows individuals to file legal action for false claims against the federal government.

The federal government takes health care fraud very seriously, with government holding healthcare facilities and companies to a high standard when processing claims.

“The Department of Justice is determined to hold accountable health care providers that improperly use taxpayer funded health care programs to enrich themselves … Kickback schemes corrupt the health care system and damage the public trust,” said Acting Assistant Attorney General for the Justice Department in a press release.

The federal government further states that any individual who witnesses any kind of fraud should come forward to report it, and may be eligible to receive compensation depending on the settlement rewarded. Whistleblowers typically receive 15 to 30 percent of the reward recovered and must be the primary source of the evidence of fraud. This means the individual must witness the fraud directly, and cannot hear it from secondary sources.

In addition to providing rewards to whistleblowers, the False Claims Act also provides protection against retaliation from employers.

This Tricare False Claims Lawsuit is Case No. 15-CV-62617, in the U.S. District Court for the Southern District of Florida.