Monty Ray Grow, of Tampa, Florida, was charged yesterday, December 13, 2016, with numerous federal health care fraud crimes related to a compounding pharmacy fraud scheme in the Southern District of Florida.
According to the allegations in the indictment, between September 2014 and June 2015, Grow received approximately $20 million in kickbacks from a Broward County, Florida compounding pharmacy in exchange for recruiting and referring patients that were covered by the Tricare health care insurance program. The Tricare program is responsible for providing medical coverage for military personnel, military retirees and military dependents worldwide. The Indictment further alleges that Grow and others defrauded Tricare by paying telemedicine companies to provide compounded medication prescriptions to the recruited patients without conducting any physical examination of the patients as required by law, and that these invalid prescriptions were issued without regard to the patients’ medical necessity. The Indictment alleges Grow laundered cash proceeds of the fraud and kickback schemes through purchases of real estate, luxury vehicles and securities.
Grow played two seasons in the NFL with the Kansas City Chiefs in 1994 and the Jacksonville Jaguars in 1995, he also played college football at the University of Florida. In the indictment, Grow was charged with conspiracy to defraud the United States and to pay and receive health care kickbacks; health care fraud; receipt of kickbacks in connection with a federal health care program; payment of kickbacks in connection with a federal health care program; money laundering and causing the misbranding of drugs while held for sale
This indictment follows several other recent criminal and civil cases involving compounding pharmacy fraud targeting the Tricare program. Prior to a revision of the Tricare compound medication reimbursement policies in 2015, fraudsters widely abused the program, causing an estimated $2 billion in fraudulent billings from 2013-2015. Many of these Tricare compound pharmacy fraud schemes were based in Florida, including a $175 million scheme in based in South Florida, multiple cases in the Jacksonville area resulting in over $35 million in civil recoveries and a similar South Florida criminal case alleging $31 million in Tricare compound pharmacy fraud.
The perpetrators of these fraudulent schemes often seem to be following the same playbook. They essentially realized that Tricare — in efforts to provide the best possible healthcare for our active military, veterans and their families — would provide high reimbursements for compounded medications. The perpetrators then undertook schemes to recruit as many Tricare beneficiaries as possible by offering recruiters, like Grow, illegal kickbacks for patient referrals. The compounding schemes also frequently used tele-marketing services to cold-call service members and their families to solicit compound medications, without regard for medical necessity. These medications, often mixtures of common ointments labeled as “pain creams,” were then mailed to Tricare beneficiaries and the pharmacy operators submitted highly inflated bills to Tricare. In some cases, the perpetrators billed as much as $31,000 for single tube of “pain cream” medication.
With compounding fraud cases on the rise, whistleblowers coming forward with information regarding these types of fraudulent schemes are necessary to stamp out this dangerous and wasteful fraud. Under the qui tam provisions of the False Claims Act, whistleblowers with information about compounding pharmacy fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government. The whistleblower, who originally filed the case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.
To learn more about compounding pharmacy fraud, click here.