The lawsuit was pursued by the United States against PCA for allegedly paying kickbacks to outside “marketers” targeting military members and their families for prescriptions for compounded creams and vitamins, which were formulated to ensure the highest possible reimbursement from TRICARE. The United States alleged that the marketers paid telemedicine doctors who prescribed the creams and vitamins without seeing the patients, or in some cases, even speaking to them. The settlement also resolves the United States’ allegations that PCA and a marketer routinely jointly paid the copayments owed by patients referred by the marketer, without any verification of the patients’ financial needs, and then disguised the payments as coming from a sham charitable organization, which was affiliated with the marketer. Finally, the settlement resolves the United States’ allegations that PCA continued to claim reimbursement for prescriptions referred by the marketers despite regularly receiving complaints from patients that revealed the prescriptions were being generated without patient consent or a valid patient-prescriber relationship. RLH, the private equity firm that managed PCA on behalf of its investors, allegedly knew of and agreed to the plan to pay outside marketers to generate the prescriptions and financed the kickback payments to the marketers. Patrick Smith and Matthew Smith were executives of PCA who allegedly executed the scheme.
The lawsuit resolved by the settlement was originally filed under the whistleblower (or “qui tam”) provisions of the False Claims Act by Marisela Medrano and Ada Lopez, two former employees of PCA. The qui tam provisions permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The False Claims Act authorizes the United States to intervene and take over such lawsuits, which the United States did here, in part. The share to be awarded in this case has not been determined yet.