ORLANDO -- A Florida compound pharmacy owner is the latest proprietor
in an ongoing probe to agree to reimburse the federal government millions of dollars in
fines over alleged billing violations of the Department of Defense’s TRICARE program.
QMedRx co-owner Mark Gilmore’s sworn arrangement to pay
back $4.25 million in fines over abuses to the military health care program makes
him at least the fourth partial owner of the Maitland-based operation to agree
to a multimillion-dollar settlement and brings to $20 million the overall amount
that government officials have negotiated to collect from company owners.
In all, the U.S. District Court for the Middle District of Florida has recovered
nearly $70 million in fines and penalties from owners across the region accused
of such overbilling practices during the past 18 months.
Compounded medicines are typically used for patients
requiring liquid formulations because of difficulty in swallowing pills.
Nationally, TRICARE paid $1.75 billion for these medicines
during fiscal year 2015, an increase reported to be at least 18 times the
amount paid in 2012. Overall, the cost for the medicines accounted for nearly 20
percent of Tricare’s estimated $9.14 billion prescription drug budget in 2015.
In the case of QMedRx, company officials are alleged to
have systematically charged federal health care programs fees that are not
covered under any plan for a yearlong period commencing in January 2013.
Other QmedRx owners who have also reached settlement
agreements with the government include Andy Miller and Tracy Miller who, along with
the Hallmark Investment Trust, have arranged to pay back $7.75 million.
“The government has been investigating TRICARE fraud for
some time and how they were being reimbursed at astronomical rates for
nonsterile compounds,” Andrew S. Feldman, managing member of the Feldman Firm that represents individuals and criminals in white collar crimes,
told the Florida Record.
under the name Home Care Solution, QMedRx operates as a compounding pharmacy
that serves doctors and patients alike. The company specializes in the kind of
therapy that offers relief for pain, scar and wound care through the primary
use of transdermal creams and gels that range in price from $600 to $1,500 per
The announced settlement was brokered by the Health Care
Fraud Prevention and Enforcement Action Team (HEAT), which was launched by the
government in 2009 to root out such corruption. Since then the U.S. Justice
Department has recovered nearly $31 billion through False Claims Act cases,
well more than half that amount stemming from fraud against federal health care
“The government targets industries where it sees large
change in terms of where the money is going,” added Feldman alluding to all the
increased scrutiny in the compounds’ industry. “All of a sudden there was a
large change in reimbursements for TRICARE.”
prescription drug costs at an all-time high, the government estimates federal
agencies have recently paid out as much as $2 billion for tainted and
unnecessary compound prescriptions.
far, U.S. Air Force reserve member Randy John Papanek is the only person in the
QMedRx case charged in a criminal indictment, which seeks a judgement against
him of $87,500.
who has already pleaded guilty to charges of conspiring to accept and pay bribes,
is scheduled to go before U.S. District Judge Roy B. Dalton Jr. for sentencing Dec. 12 in Orlando.
In exchange for various forms of kickbacks over a
two-year period starting in 2013, Papanek is said to have recruited people
covered by TRICARE and steered them into seeking prescriptions only from QMedRx doctors.
As a Tricare beneficiary, he is also accused of
receiving payments for receiving his own prescriptions from those same doctors.
“It’s going to continue,” Feldman predicted of the
TRICARE government crackdown. “Those who are serious about being in the non-sterile
compounds industry will find a way to make the necessary changes to be