Defending Compound Pharmacies in Tricare Fraud Investigations

In early 2015, Tricare, which provides insurance coverage to U.S. military members and their families, held a meeting with representatives of the compounding and pharmaceutical industries.  The impetus for this meeting was Tricare’s realization that the average compounded drug billed to Tricare cost approximately $ 3,300 and that Tricare had paid $ 240 million in compound claims in February 2015 alone.  After this meeting, Tricare implemented a new series of requirements for billing such compounds, which went into effect on May 1, 2015.  For example, there is now a pricing schedule addendum that lists the accepted prices for common compounding agreements.  Any provider submitting claims to Tricare for compound pharmaceuticals must adhere to these prices for its ingredients.

In addition to instituting new rules for billing practices, the government has begun aggressively pursuing compounding pharmacies for Tricare fraud.  Common allegations against compound pharmacies include kickbacks, overbilling, billing for unnecessary products, and providing automatic on-going refills.  This year, four Florida pharmacies agreed to pay $12.8 million to the government after an investigation into billing practices for scar and pain creams.  Similar investigations have been opened in many other states, including Texas and Mississippi.

Our Experience

These examples— and the trend by the U.S. government to investigate and prosecute the compound pharmacy industry in relation to Tricare claims— suggest that those in the industry would be wise to retain lawyers that have mastered the complexity of the healthcare industry with its convoluted rules and regulations, as well as understanding how to litigate and defend against unjust healthcare fraud allegations.

Put our highly experienced team on your side

Dr. Nick Oberheiden

Founder

Attorney-at-Law

Lynette S. Byrd

Former DOJ Trial Attorney

Partner

Brian J. Kuester

Former U.S. Attorney

Amanda Marshall

Former U.S. Attorney

Local Counsel

Joe Brown

Former U.S. Attorney

Local Counsel

John W. Sellers

Former Senior DOJ Trial Attorney

Linda Julin McNamara

Federal Appeals Attorney

Aaron L. Wiley

Former DOJ attorney

Local Counsel

Roger Bach

Former Special Agent (DOJ)

Chris J. Quick

Former Special Agent (FBI & IRS-CI)

Michael S. Koslow

Former Supervisory Special Agent (DOD-OIG)

Ray Yuen

Former Supervisory Special Agent (FBI)

The former prosecutors and experienced defense counsel at Oberheiden, P.C. are being called on by clients across the country to help out in situations of need. Our strength is based on three abilities and objectives:

Our Approach

Industry Knowledge. Besides representing a plethora of clients in general healthcare fraud cases, we also assist a large number of clients from across the United States in structuring business arrangements legally. This allows us to have utmost familiarity with the nuances of the pharmacy and compound pharmacy industry. For example, we have set up and assisted with:

• Pharmacy Kickback Defense
• Pharmacy Healthcare Fraud Defense
• Pharmacy DEA Audit Assistance
• Pharmacy DEA Show Cause Preparation
• Pharmacy Diversion Conflict
• Pharmacy DEA Licensing Issues
• Purchases of State and DEA Licensing

Our attorneys have analyzed, reviewed, and defended close to 500,000 billed pharmacy claims. Similarly, if you are accused of overbilling or kickbacks, you need lawyers that understand the legal requirements of the pharmacy industry to get your case dismissed.

Government Experience. Another strength of Oberheiden, P.C. is its team approach. All cases are being handled by former federal prosecutors with a wealth of insight knowledge. Together with managing partner Dr. Nick Oberheiden, former Department of Justice officials handle all cases personally. We only take on a limited number of clients. Those that we do accept as clients benefit from a concierge-type representation that allows 24/7 access to senior attorneys. Our attorneys have extensive knowledge and competence in handling any fraud allegations in the healthcare industry.

Our Track Record

We have successfully defended individual and corporate healthcare providers in OIG, DEA, FBI, and Department of Defense investigations across the country. Give us a call and benefit from our experience and reputation. Find out how a former chief healthcare prosecutor from the U.S. Attorney’s Office assesses your case.

If you would like to talk to someone who understands healthcare, litigation, and fraud defense work, you should hire an experienced attorney at Oberheiden, P.C..

This information has been prepared for informational purposes only and does not constitute legal advice. Reading of this information does not create an attorney-client relationship. Prior results do not guarantee similar future outcomes. Oberheiden, P.C. is a Texas PC with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.