Sales Rep for North Alabama Compounding Pharmacy Charged in $13 M Insurance Conspiracy

[nitpicker]

https://www.justice.gov/usao-ndal/pr/sales-rep-north-alabama-compounding-pharmacy-charged-13-m-insurance-conspiracy-0

Department of Justice
U.S. Attorney’s Office
Northern District of Alabama

FOR IMMEDIATE RELEASE
Tuesday, May 9, 2017

Sales Rep for North Alabama Compounding Pharmacy Charged in $13 M Insurance Conspiracy

BIRMINGHAM – Federal prosecutors today charged a sales representative for a Haleyville, Ala.,-based compounding pharmacy with conspiracy in a multi-faceted scheme to generate prescriptions and defraud Blue Cross Blue Shield of Alabama and one of its prescription drug administrators out of over $13 million in one year. Acting U.S. Attorney Robert O. Posey, Federal Bureau of Investigation Special Agent in Charge Roger Stanton, United States Postal Inspector in Charge, Houston Division Adrian Gonzalez, U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Derrick L. Jackson, and Defense Criminal Investigative Service Special Agent in Charge John F. Khin announced the charges.

The U.S. Attorney’s Office filed a four-count information in U.S. District Court charging ROBIN GARY LOWRY, 49, of Columbus, Miss., with conspiring between October 2014 and November 2015 to defraud BCBS of Alabama and Prime Therapeutics, the entity that processed prescription drug reimbursement claims for BCBSAL. The information also charges Lowry with three counts of health care fraud for submitting fraudulent claims for payment to BCBSAL.
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Global recruited close relatives of doctors and other prescribers as sales representatives. It also encouraged employees to work, typically without pay, at prescribers’ offices where they were to review patient files in order to recommend and encourage use of Global's products.

Global also frequently instructed its employees to obtain high-reimbursing, but medically unnecessary prescriptions for Global products for themselves and their family members, and waived co-pays for these products. A July 2015 email from a Global sales executive to other pharmacy employees encouraged every sales representative and district manager to get a prescription “for themselves and every eligible family member” for SilaPak, a high-reimbursing “topical skin repair complex.” “So far we have 15 reps and one [district manager] who have gotten at least one in. If we get everyone in the week that would be around 45-50 depending on the family. At 50 that is $220,000 in revenue and we need it,” the email said.

Lowry obtained prescriptions from a prescriber with whom she had a close familial relationship, and who sometimes issued the prescriptions to people without talking to or having a doctor-patient relationship with them. Lowry also frequently forged prescriptions from her relative, according to the charges and her plea agreement.

In July 2015, Lowry sent Global a forged SilaPak prescription for the three-year-old child of a Global employee, even though Global’s own marketing materials warned that the SilaPak cream was not to be used for children. Global filled the prescription and mailed a refill of it for the child to Santa Rosa Beach, Fla., in August 2015.
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