Compounding pharmacies work so hard to offer services to their clients. However, sometimes their efforts don’t get the approval of government regulators.
When investigators from the federal government launch inquiries concerning fraud in these businesses, their operations can greatly be hampered. The consequences can even be greater if a business doesn’t get a strong legal team to defend itself.
Because of the rise of fraudulent activities in the health sector, the federal government has also increase crackdowns on businesses that flaunt practices and guidelines mean to protect federally funded programs.
If you operate a pharmacy and don’t understand whether your claims for Tricare are in order or not, then you are putting your business at risk. The best way to stay safe is by retaining an experienced healthcare lawyer.
Need for a proper Tricare claim defense
Why are fraud cases of compounding pharmacy a major concern for most of the industry players?
First of all, it is important to understand the recent history before we delve into this crucial jurisprudence. It’s only experienced lawyers who can understand and interpret laws surrounding compounding pharmacy fraud cases.
Compounding Pharmacies and the Federal Government
There’s no doubt that compounding pharmacies play a crucial role in the healthcare industry through the manufacture of distinct drugs that are traditionally unavailable for patients.
This means that they help in bridging the shortages often experienced. They also offer alternatives for patients who suffer from special conditions such as drug allergies.
The department of Defense’s Tricare program gives a number of health benefits for various military and ex-military officers together with their dependents. This makes it risky for anyone to operate a Tricare business compared to other businesses – because of the oversight from the federal government.
Several compounding pharmacies have already learned their lessons the hard way. Ten people were convicted and charged for the role they played in defrauding the government $100 million in 2016. The scheme involved both marketers and physicians who were accused of giving kickbacks.
Cases involving compounding pharmacies fraud may take long but when they happen, the accused can face tough penalties.
A good example is a case that happened in 2019 when a businessman was accused of attempting to defraud Tricare. He was charged with 15 counts – charges that can result in a lifetime prison sentence and $10 million fine.
Another case that shows how determined the federal government is in prosecuting the so-called criminals occurred in 2019 when a nurse working at the Air Force pleaded guilty for having participated in a kickback scheme.
In this case, pre-printed prescriptions were sent to military officers to seek particular drugs from their physicians.
Such cases might appear a drop in the ocean but the truth is that every compounding pharmacy is at risk of finding itself in the middle of Tricare fraud investigation. This is irrespective of whether you are operating your business by the book or not.
Building a robust defense
Dealing with Tricare fraud cases can be a major hurdle for anyone who is not experienced. The problem is that prosecutors from the federal government can even complicate the case by introducing news charges and involving various healthcare fraud acts.
Consequently, understanding your way around the legal system is important because not all cases will turn out the same way. For example, your pharmacy may get a notice from the DEA about the upcoming audit or get notified of a federal lawsuit.
In some cases, the Federal Investigation Bureau (FBI) might initiate investigations on your pharmacy before inviting another federal investigation agency.
What can a Tricare defense lawyer help?
There’s more than lawyers do other than defending companies in the court. They also put your interest first right from the start of the case. For example, they will help in putting up all the crucial details that will be required to prove your innocence.
The most important thing is to ensure that you collaborate with them and provide all the necessary information about your business. Hiding anything from your lawyer can jeopardize the case.
In general, Tricare compounding pharmacies are always at risk of getting into trouble with the federal government. This is because they are often under the radar of federal agents in terms of audits and following the anti-kickback and fraud laws.
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