Pharmacist And His Employee Convicted Of Over $30 Million Health Care Fraud Against Military Insuran

[nitpicker]

https://www.justice.gov/usao-sdfl/pr/pharmacist-and-his-employee-convicted-over-30-million-health-care-fraud-against

Department of Justice
U.S. Attorney’s Office
Southern District of Florida

FOR IMMEDIATE RELEASE
Monday, September 18, 2017

Pharmacist And His Employee Convicted Of Over $30 Million Health Care Fraud Against Military Insurance Program

Benjamin G. Greenberg, Acting United States Attorney for the Southern District of Florida; John Khin, Special Agent in Charge, Department of Defense Criminal Investigative Service (DCIS), Southeast Field Office; Maximo Eamiguel, Special Agent in Charge, United States Postal Service, Office of Inspector General (USPS-OIG), Southern Area Field Office; James T. Wallis, Special Agent in Charge, U.S. Army Criminal Investigation Command, Southeast Fraud Field Office; Justin D. Green, Special Agent in Charge, U.S. Food and Drug Administration (FDA), Office of Criminal Investigations, Miami Field Office; and Scott Rezendes, Special Agent in Charge, United States Office of Personnel Management, Office of Inspector General (OPM-OIG), announced the conviction of Serge Francois and Patrick Tonge for their involvement in a conspiracy to commit health care fraud and pay kickbacks in connection with federal health care programs. The fraudulent scheme caused over $30 million in losses to the federal TRICARE program. TRICARE provides coverage for active duty military and their families, as well as retired veterans. In addition, the fraudulent scheme caused the Federal Employee Health Benefit Program (FEHBP) to sustain losses.
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According to evidence presented at trial, Francois, a pharmacist, owned and operated Atlantic Pharmacy and Compounding, located in Pompano Beach, Florida. From there, Francois and his right-hand man at the pharmacy, Patrick Tonge, entered into a vast conspiracy with so-called marketers who paid physicians to write prescriptions for topical medications that cost up to $17,000 a bottle. As the pharmacist in charge, Francois was responsible for the compounded medications, which were made in-house by the pharmacy.

Francois, Tonge and their co-conspirators agreed to automatically refill the prescriptions, sending numerous refills to patients who did not request them or need them, while not charging a co-pay in hopes that the patients would not bother to return the medications. Francois and Tonge would pay the marketers out of the profit received for each prescription; and the marketers in turn would pay the physicians. Evidence further showed that a substantial portion of the scheme involved physicians never seeing or examining the purported patients. Rather, they used the patients’ personal identification information to write the prescriptions.

Testimony and other evidence at trial revealed that Francois and Tonge specifically targeted the TRICARE program. Through the conspiracy, Atlantic Pharmacy billed over $37 million to TRICARE and FEHBP, with TRICARE paying out over $30 million in false and fraudulent claims.
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In addition, trial evidence revealed the kickback conspiracy component of the fraud scheme. For example, the marketers told Francois and Tonge that if they did not get paid they could not pay the physicians, and thus the physicians would stop writing the prescriptions. Francois and Tonge continued to make payments and bill TRICARE up until May 2016, when TRICARE stopped covering the medications due to growing knowledge of similar fraud involving other compounding pharmacies. In total, seventeen individuals pled guilty or were convicted for their involvement with the fraudulent scheme or receipt of kickbacks.
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