Feds sue S.A. doctor in Tricare kickback scheme
The federal government is suing a San Antonio doctor and others for allegedly accepting kickbacks in exchange for prescribing pain-relief creams and other medications that weren’t medically necessary.
The prescriptions were then billed to a Department of Defense health program.
Dr. Alex De Jesus hosted a 2015 seminar at the Doubletree Hilton Hotel on Northeast Loop 410 where he spoke to a group of Tricare beneficiaries about the benefits of the creams. He wrote prescriptions for some of them without performing medical examinations, the U.S. attorney’s office alleges in a lawsuit filed Monday.
De Jesus, a rheumatologist who treats arthritis patients, then presented for payment fraudulent claims to Tricare in return for kickbacks from Dallas medical supplier Marlin Medical Solutions LLC, the suit alleges.
Tricare is a health insurance program for military members, their dependents and retirees.
Marlin Medical owner David Marlin Edwards paid various people, including a San Antonio football agent and an area pastor, to get Tricare beneficiaries to attend De Jesus’s seminar and two other seminars featuring other doctors, the complaint says.
The Tricare beneficiaries who attended the seminars received up to $250 each for meeting with one of the physicians. That was pocket change compared with the
millions of dollars that Tricare paid in reimbursements for the hundreds of prescriptions written for those beneficiaries, the lawsuit alleges.
The government seeks at least $2.6 million in damages from the defendants, but it wants that amount tripled. It also seeks civil penalties between $5,500 and $11,000 for each false claim that was presented Feb. 24May 1, 2015.
De Jesus and two other doctors, Marlin Medical and Edwards, and three pharmacies have been sued under the False Claims Act and the Anti-kickback Statute.
De Jesus also has been sued for allegedly having his signature on four blank prescriptions for controlled substances discovered on Nov. 15, 2016, the same day the FBI executed a search warrant of his San Antonio office. The government seeks as much as $62,500 for each of the four alleged violations of the Controlled Substances Act.
A call to De Jesus, 61, wasn’t returned Wednesday. He has no disciplinary history, according to the Texas Medical Board’s website.
Marlin Medical’s Edwards declined to comment. He’s accused of contacting De Jesus and the other two doctors — Richard Niemeyer of Lancaster, Pa., and Latisha Rowe of Houston — to participate in signing medically unnecessary prescriptions for “breakthrough” creams.
De Jesus wrote 185 prescriptions for compounded drug products to 59 Tricare beneficiaries, though some were reversed by Tricare. Additionally, there were 42 refills. Compounding involves the combining of two or more drugs. The prescriptions and refills were filled by Rite Care Pharmacy, which has locations in Dallas and Richardson.
Tricare paid Rite Care more than $1 million for the prescriptions and refills, the actions states. The lawsuit references payments Rite Care made to Marlin Medical but no amount is shown.
The lawsuit cites only one payment of $2,500 that Edwards made to to De Jesus.
Niemeyer had a medical license that expired at the end of 2018. The lawsuit says Marlin Medical hosted a seminar in December 2014 at the Omni Colonnade Hotel in San Antonio. After the audience was told about the benefits of the creams, the suit says, Niemeyer filled out a “compound prescription request form for each beneficiary reflecting which pain or scar creams, or ‘general wellness’ products were prescribed.”
After meeting with Niemeyer individually, attendees provided their Tricare beneficiary cards to the recruiters and received up to $250 each, the complaint says.
Niemeyer wrote 227 prescriptions for one or more compounded drug products to 105 Tricare beneficiaries. There also were 362 refills of those prescriptions.
Medscript Pharmacy LLC in Illinois filled all of Niemeyer’s prescriptions and refills by mail, the suit says. Medscript received about $5.3 million in reimbursements from Tricare for those orders, and then paid Edwards a total of nearly $1.2 million, the suit says. A call to Medscript was not immediately returned.
“The scheme was highly profitable for Edwards and Marlin Medical,” the suit states.
Niemeyer received a total of $7,500 in two checks from Marlin Medical. He couldn’t be located for comment.
Rowe, the Houston doctor, allegedly was part of a Feb. 7, 2015, seminar at the Doubletree. She and her business received a total of $26,500 in two checks from Marlin Medical, the lawsuit says.
She allegedly wrote 40 prescriptions for 20 Tricare beneficiaries, according to the suit. There also were 29 refills. Tricare paid Rite Care almost $569,000 for those 69 claims, the complaint adds. Rowe didn’t immediately respond to a request for comment. A Rite Care official had no comment.
The lawsuit alleges that Edwards paid the football agent, pastor and two Air Force retirees to market the seminars to Tricare beneficiaries. The four were only identified in the lawsuit by their initials. They are not defendants in the case.
The agent, identified as “J.G.,” is listed as the manager of Griff3 Enterprises LLC of San Antonio. State corporate records show the manager as Jeff Griffin. He didn’t immediately respond to a request for comment. J.G. and Griff3 received almost $377,000 from Edwards, the suit says.
J.G. and the two Air Force retirees formed another company, JKS Research LLC, that received more than $230,000 from Edwards, the complaint adds.