Federal law enforcement is investigating compound pharmacists. As a result, federal prosecutors are more frequently charging pharmacists with violating several laws, most commonly, the anti-kickback statute and the health care fraud statute.
The typical federal investigation focuses on three players: the pharmacist, the marketer and the doctor. The marketer pays a doctor to write prescriptions for certain types of medicine. The doctor often prescribes the medicine even though it is not medically necessary. The marketer and/or the doctor ensure that the prescription is filled at a particular pharmacy. The pharmacist fills the prescription and then bills a federal health care benefit program. The pharmacist receives the money from the federal agency and then pays the marketer some portion of that money – usually an agreed-upon percentage of the amount of money the marketer was responsible for sending to the pharmacy.
The government charges these three players with serious crimes. The indictment will allege that the players conspired to violate the anti-kickback statute and conspired to commit health care fraud. Also, the indictment will allege that the three players actually committed the substantive offenses of paying illegal kickbacks and defrauding a federal health care benefit program. Then, for good measure most indictments also allege conspiracy to launder money.
The indictment in the typical health care fraud case subjects pharmacists and marketers and doctors to possibly spending decades in prison.
In future blog posts I will discuss the law as it relates to health care fraud and the defenses available to pharmacists and marketers and doctors.