South Florida Pharmacist and Pharmacy Technician Charged in Multi-Million Dollar Health Care Kickback Case
In the early 1990s, Monty Grow was a standout defensive back at the University of Florida. After his time in Gainesville, Mr. Grow spent two years playing for the NFL’s Jacksonville Jaguars. However, his playing career was not nearly as lucrative as his career in the health care industry—one that landed him jail after he was convicted of taking nearly $20 million in illegal kickbacks.
The investigation into the health care fraud scheme continues to expand. According to a report from the Miami Herald, two South Florida pharmacists have been charged in what is now an $87 million medical billing fraud case. Here, our Miami physician management litigation attorneys provide an overview of the allegations against the South Florida medical professionals.
Miami Prosecutors Allege Medical Billing Fraud: Prohibited Kickbacks
In April, prosecutors charged Matthew Smith, a pharmacist, and Alisa Catoggio, a pharmacy technician, with conspiracy to commit health care billing fraud as part of a massive illegal kickback scheme. They pair is accused of overbilling and fraudulently billing the federal government for medications that were extremely expensive and, at times, unnecessary. The scheme involving Mr. Smith and Ms. Catoggio is allegedly related to the former NFL player Monty Grow.
The prescription drugs in question were costly pain creams—and they were offered to former military members to treat scarring. Court records indicate that Florida’s PCA pharmacy was spending about $700 to fill the prescriptions and billing the federal government more than $15,000. Mr. Grow and his marketing team would then receive around $6,900 for each referral to the pharmacy. The conduct alleged by prosecutors constitutes an illegal kickback under federal law. It became a criminal issue because many of the products were sent to people who did not actually need them at all.
Kickback Violations: Strict Federal Rules
There are very strict rules—both criminal and civil—prohibiting kickbacks in the pharmaceutical industry and the medical device industry. Notably, federal regulations define the term ‘kickback’ in a relatively broad manner. It encompasses the provision of anything of value in exchange for referrals that are then billed to a federal health program.
While the alleged violations in this case are significant, federal regulators will take civil action against medical practices in many other circumstances. Florida pharmacists and medical professionals should be extraordinarily cautious and avoid any prohibited kickbacks for referrals. Under federal law, companies that violate referral rules could be subject to large financial penalties and, potentially, disqualified from participating in federal health programs, including Medicare, Medicaid, and Tricare. For many medical practices, a ban from federal health programs could all but destroy the business.
Consult With Our Florida Physician Practice Litigation Attorneys Today
At Pike & Lustig, LLP, our Florida business lawyers have extensive experience representing medical practices. If you have questions about your rights or options, we can help. Call us today for a completely confidential consultation. We serve clients throughout Southeastern Florida, including in Miami, Hialeah, Kendall, Weston, Pembroke Pines, Aventura, Hollywood, Hallandale Beach, and Miramar.