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Arkansas man sentenced in insurance fraud

Judge orders 15 months for violating anti-kickback statute by Linda Satter | May 11, 2019 at 2:21 a.m.

A former Fort Smith medical sales representative was sentenced Friday to 15 months in federal prison for his role in a multimillion-dollar conspiracy to defraud Tricare, the health insurer for the U.S. military.

Brian Means pleaded guilty Nov. 28 to a charge of conspiring to violate the federal anti-kickback statute. He admitted he was one of several people, known as patient recruiters, who between December 2014 and July 2015 supplied names of Tricare beneficiaries. Phony prescriptions for expensive compounded medications were filled in the beneficiaries' names at a Mississippi compounding pharmacy.

A woman who was a medical assistant in Little Rock created prescriptions in those names, forging the signature of a Little Rock doctor for whom she worked. Brad Duke, a medical sales representative in Little Rock who prosecutors said was the ringleader of the Arkansas scheme, then submitted the prescriptions to the pharmacy, which was paid by the insurance company. The pharmacy paid Duke large commissions and he, in turn, paid others below him in the scheme, prosecutors have said.

The woman -- Charlotte Leija, 38, of Conway -- and Duke, 43, of Little Rock are among those who have pleaded guilty. Leija was sentenced last month to 18 months in prison and was ordered to forfeit more than $253,000 that she profited from the scheme. She admitted authorizing the maximum number of refills for each phony prescription.

Duke is awaiting sentencing.

The expensive medications were primarily pain cream, scar cream and supplements.

U.S. Attorney Cody Hiland has said the conspiracy generated more than $10 million in phony prescriptions over a year's time, and was part of the reason that nationally, Tricare paid nearly $2 billion for compound prescriptions in 2015, an 18-fold increase over previous years that prompted investigations in several jurisdictions, including in the Eastern District of Arkansas.

Prosecutors said Means took $212,000 in kickbacks, which included $70,000 for paying for a former co-worker and his wife to receive over $367,000 in compounded drugs.

In March, the presiding judge, Chief U.S. District Judge Brian Miller, sentenced another former medical sales representative, Michael Sean Brady of Little Rock, to eight months in prison. Brady received over $484,000 in payments over four months, but had paid back $312,141 by the time of sentencing.

Brady said Duke had contacted him about helping "promote" certain medications through a deal Duke had made with the pharmacy -- MedwoRx Compounding Pharmacy -- and that Brady at first didn't realize the arrangement was unorthodox and criminal.

Metro on 05/11/2019

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