How To Defend Compound Pharmacies in Tricare Fraud Investigations

Defending Compound Pharmacies in Tricare Fraud Investigations

Compounding pharmacies work extremely hard to serve their clients. Unfortunately, their efforts don’t always earn the approval of regulators. When the feds pursue legal action against these enterprises, the pace of doing business can change immediately. Entities that aren’t prepared to take a strong legal stance inevitably suffer the consequences.

The government is cracking down on businesses that run afoul of the guidelines and best practices for billing federally operated programs. If you run a compounding pharmacy and aren’t sure whether your Tricare claims might be on shaky ground, then you’re jeopardizing your future. Here’s how retaining an attorney from the Healthcare Fraud Group can help.


The Need for Sound Tricare Claim Defense

Why are compounding pharmacy fraud cases such a concern for modern pharma players? Understanding recent history is crucial to navigating through these dangerous jurisprudential waters. Our legal advisors strive to keep you in the know so that you remain in the strongest position possible.


The Government and Compounding Pharmacies

Compounding pharmacies play significant roles in modern healthcare by manufacturing unique drugs for patients who require normally unavailable prescriptions. In the process, these forward-thinking businesses help fight shortages and provide essential alternatives for individuals who suffer from conditions such as drug allergies.

The U.S. Department of Defense’s Tricare program provides health benefits for a broad range of military and ex-military service members. It also serves their dependents. These realities make operating as a Tricare service provider a bit riskier than other business models because such government initiatives are subject to substantial oversight.

Some compounding pharmacies have learned this lesson at their own expense. In 2016, ten people were charged for their roles in defrauding the system of $100 million in a scheme complete with kickbacks paid to physicians and marketers. In addition to facing significant jail time and fines in the hundreds of thousands of dollars, the accused were made to forfeit large amounts of property and assets.

Complaints and lawsuits targeting compounding pharmacies may take time to gain steam, but when they manifest, they can pack a serious punch. One 2019 incident resulted a businessman charged with plotting to defraud TRICARE in a complaint that included 37 counts, a potential $10 million in fines, and a possible lifelong prison sentence.

Other episodes reveal how serious the government is about bringing so-called criminals — and their accomplices — to justice. In 2019, an Air Force nurse pleaded guilty to participating in yet another kickback scheme. In this clear example of fraud, the servicemember sent pre-printed prescriptions to service members so that they would seek specific drugs from their doctors.

Such cases might seem like little more than outliers considering the vast majority of legitimate compounding pharmacies that work with Tricare. On the other hand, the fallout of such highly publicized events has undeniable impacts on the sector as a whole. Operating a business that does everything by the books might not prevent you from becoming a target.

Government regulators hoping to preclude a repeat of prior misdeeds have grown even more watchful. It falls on you to prove that you’re doing the right thing as you deal with the Federal Health System.

Building a More Robust Defense

Navigating the legal code can be very risky for the uninitiated. Prosecutors may complicate the situation even further by packing their indictments with related charges and targeting large groups of individuals or entire organizations. Such practices can make it extremely difficult for a business leader to begin laying the foundations of a worthy defense strategy.

Knowing your way around the legal system is vital because not all cases unfold in the same fashion. For instance, your pharmacy may receive notice of a pending DEA audit or simply be served with a federal suit. In other instances, you might start off by being investigated by the FBI before another DOJ agency steps in and takes over.

How can pharmacies make it through invariably convoluted legal processes in one piece? Reaching out to a Tricare fraud attorney with a Tricare claim defense experience is the most viable option.


What Can a Legal Advocate Do For Your Enterprise?

Attorneys do more than merely defend companies in the courtroom. They also serve your best interests in the crucial preparatory stages of cases. By examining the strength of the government’s arguments against you, we can help you choose the most cost-effective defense strategy and safeguard your corporate success.

Being legally well-read isn’t enough. Theoretical knowledge works best when it’s paired with experience, so your legal partner must have the first-hand expertise to keep pace with evolving case developments. For instance, your firm should be well-versed in dealing with matters that involve multiple federal agencies. They shouldn’t be caught off-guard when prosecutors produce new evidence against you. If your case takes a sudden turn, they need to anticipate the necessary defense strategy adaptations required to respond appropriately. Above all, they should keep you educated about your options and where you stand at all times so that you can continue to serve those who depend on your business leadership.


How the Healthcare Fraud Group Helps

At the Healthcare Fraud Group, our attorneys know how to defend enterprises against government cases that seem untenable. Unlike many firms, we’ve worked on both sides of the aisle as prosecutors and defense attorneys. This extensive track record grants us a uniquely informed perspective on protecting those who make it their mission to provide vital pharmaceutical services.

Our defense expertise reflects a century’s worth of combined litigation experience. We firmly believe that leveraging our knowledge for our clients contributes to a more efficient, robust healthcare industry — as well as the establishment of legal precedents that serve patients, care networks, and stakeholders.

We’re passionate about advancing the dialog surrounding fraud-related cases involving the federal health system. With decades of practice as trial lawyers and attorneys working on behalf of the DOJ and similar government entities, we recognize the value of building bridges and helping parties come to more harmonious understandings. Our professional associations and longstanding relationships will work to your advantage as you strive to clear your name, correct prior mistakes, and implement corrective measures for the future.


Empowering Healthcare Enterprises With Superior Defense Options

The Healthcare Fraud Group team is proud to help clients identify better alternatives to expensive, time-consuming courtroom battles. For instance, we can help you ascertain whether it might be advisable to seek a case dismissal instead of mounting a defense. This little-known corporate defense option often proves critical for those companies that want to continue doing good work without their records being marred by high-level civil or criminal convictions.

It’s far easier to make sound legal choices when you’re mindful of their ramifications. We will help you understand the nature and severity of the charges you face so that you can move forward confidently. Instead of feeling lost or overwhelmed by the magnitude of your case, you can choose a course of action that best benefits your business partners, employees, and customers alike.

Our experience identifying workable answers to complex legal and regulatory challenges is unparalleled. We’ve fought to help our clients win settlements in the tens of millions of dollars, defended hospitals against arbitration actions, and secured jury verdicts on behalf of major healthcare providers.

Not every case is winnable, but a situation that looks dire doesn’t have to spell the end of your enterprise dreams. We’ve helped compounding pharmacies get back on the right track after falling afoul of the law by implementing compliance programs and taking definitive action demonstrating their willingness to prevent future mistakes.


Talk to Our Health Care Fraud Defense Lawyers Today

No matter what your corporate mission is, your healthcare business, practice, or pharmacy organization is too valuable to risk. The same goes for your future — wasting time in federal prison or destroying your reputation will have irrevocable consequences that make every aspect of life harder. If you’re currently being investigated then you’re in jeopardy, and it’s advisable to be as proactive as possible.

Reach out to the Healthcare Fraud Group today. We have the knowledge to deliver insights that you won’t find elsewhere, the legal skill set to fight fierce battles on tricky ground, and the tenacity to see your case through to a positive conclusion. Schedule a consultation with a skilled defense lawyer today by calling 888-402-4054, or get in touch online for a confidential discussion.