What is Compounding Pharmacy Fraud?

What is Compounding Pharmacy Fraud?

The term compounding is used to describe the process of combining pharmaceutical ingredients to create a specialized form or dosage of a medication. These drugs are used to help people who suffer from very specific ailments. These drugs are not regulated by the FDA due to the fact that the ingredient combinations vary greatly between patients.

As a result of not being regulated, all compounded drugs are coded as being “new drugs” and given a new National Drug Code (NDC). This code often dictates the prices that can be assigned to the medications. Some of these medications can result in medical payments of over $30,000. Pharmacies often use this loophole to exploit insurance providers and collect massive payments for medication. When pharmacies and individuals engage in this type of behavior, they are committing what is known as “compounding pharmacy fraud.” This crime comes with steep penalties and has a damaging impact on the Medicare, Medicaid, and TRICARE system.

TRICARE Compounding Pharmacy Fraud

Over the past decade, we have seen a major increase in the amount of compounding fraud targeted at the TRICARE benefits system. TRICARE is the federal government payer for health insurance for military members and their families. The amount of compounding pharmacy fraud impacting the TRICARE system went from $5 million in 2004 to over $1.7 billion in 2015. It is believed that between 2014 and 2015, there were over $2 billion in fraudulent billings for compounding drugs in the United States.

In an effort to combat these high costs related to fraud, TRICARE implemented various measures aimed to combat problems associated with people engaging in fraudulent actions toward them. People who are convicted of compounding pharmacy fraud can face an array of consequences. Some of the repercussions for this crime include:

Regrettably, the efforts to combat the problem are met with numerous false arrests. If you have been charged with compounding pharmacy fraud, it is crucial that you act quickly to protect your legal rights.

Healthcare Fraud Group Can Help You

The impacts of a healthcare fraud conviction related to compounding pharmacy fraud can jeopardize your ability to work and live. If you have been accused of compounding pharmacy fraud, working with a knowledgeable legal team can provide you with the best chances of beating your charges or having them reduced.

Our team at Healthcare Fraud Group understands the importance of proving your innocence after these horrific allegations. A conviction for healthcare fraud crimes, including compounding drug fraud, falsifying medical records, conspiracy to distribute, and distribution of controlled dangerous substances can result in a prison sentence of up to 20-years and over $1 million in fines. These charges are extremely serious and can have a devastating impact on a medical professional’s life, career, and more. If you were accused of any of these crimes, or similar forms of healthcare fraud, contact our pharmaceutical crimes defense attorneys at (888) 402-4054 to discuss your case as soon as possible.

Schedule a Confidential Initial Compliance Assessment with Our Federal Health Care Group