Jacksonville Doctors, Pharmacies Pay $10 Million To Settle TRICARE Fraud Allegation
A Jacksonville compounding pharmacy and four Jacksonville doctors who partnered to run a second pharmacy have settled with the federal government over allegations they defrauded the military’s health care program, TRICARE.
The doctors are still practicing medicine in Northeast Florida.
Without admitting wrongdoing, the doctors who run the Topical Specialists pharmacy and the WELLHealth pharmacist have agreed to pay $10 million, according to a news release from the U.S. attorney's office.
The feds contend the four physicians wrote hundreds of prescriptions for pain and scar creams. After speaking with patients, the government contends the prescriptions were often not used by patients, despite the tremendous cost to the government.
The cost to actually compound the creams was often 4 or 5 percent of the amount the government paid.
Records reviewed by the government showed the pharmacy was making up to 90 percent profit for each cream submitted to the TRICARE program. The profit was then disbursed to the doctors who wrote the prescriptions.
In some cases, the four physicians recruited other doctors to write prescriptions, promising to share revenue with them. The government alleges that in some cases, the doctors who wrote prescriptions to Topical Specialists and WELLHealth received up to 40 percent of the reimbursement.
At one point during the investigation, certain doctors suggested payments for the prescriptions were legitimate because the physicians were engaged in a “research study” to monitor the clinical effectiveness of the creams.
No patient contacted by the government knew that they were enrolled in a research study, and no research findings were ever published.
Roughly 40 percent of the prescriptions submitted by WELLHealth and Topical Specialists were written by the four physicians. Manish Bansal is a cardiologist at Baptist Hospital. Marisol Arcila is a pain management physician at Premier Spine & Pain Center. Syed Asad is a neurologist at Universal Neurological Care with practicing privileges at Baptist. Mehul Parekh is a general practice physician at Baptist Hospital. All four received hundreds of thousands of dollars in reimbursements.
In an email, a Baptist Health spokeswoman said "Baptist does not dictate to doctors how to practice medicine.”
None of the four doctors has a discipline record with the Florida Board of Medicine. A Health Department spokesman says it’s possible the state is investigating the doctors, but that wouldn’t be made public unless the probe uncovers probable cause for discipline.