Appeals court affirms conviction of physician, pharmacist in $4.4M Tricare fraud scheme

A Florida physician, pharmacist and Navy veteran lost the appeal of their conviction in a $4.4 million Tricare fraud scheme, according to a June 20 article in JDSupra from the law firm Burr & Forman. 

The lower court convictions of Nicole Bramwell, MD, pharmacist Larry Howard and Raymond Stone, a retired Navy veteran, for their involvement in a federal kickback scheme related to prescribing compounded pain creams between April 2014 and May 2015 were affirmed by the 11th Circuit Court of Appeals. 

According to court documents, Mr. Howard paid Dr. Bramwell $138,500 to write cream prescriptions to patients referred to his pharmacy. The pharmacy, Winter Springs, Fla.-based Fertility Pharmacy, gained nearly $4.4 million in reimbursements.

Tricare allegedly reimbursed $9,400 on average per prescription during that period. The high reimbursement pay, according to JDSupra, "drove Howard to shift his aptly named Fertility Pharmacy from selling fertility drugs to selling almost 90 percent compounded creams."

Mr. Howard paid Dr. Bramwell in fluctuating amounts that correlated with the reimbursement amounts paid. Over 14 months, Dr. Bramwell wrote 394 prescriptions, totaling over $3.5 million; seven other physicians wrote the remaining prescriptions during that time period.

Patients also came through Fertility Pharmacy via Mr. Stone, who falsely claimed he was a submarine veteran who had been a Lieutenant Commander in the Navy. He captured Tricare beneficiaries into the cream prescription scheme with the promise of a free water machine. 

Tricare issued a new policy in March 2015 that limited the reimbursements for compound cream prescriptions, and reimbursements fell by 98 percent. Dr. Bramwell stopped writing prescriptions in June 2015. 

The trio was found guilty in a seven-count indictment, and all appealed their convictions, claiming insufficient evidence. Mr. Howard was also indicted on two counts of money laundering. Mr. Howard and Mr. Stone were sentenced to over 13 years and two years in prison, respectively. The lower court sentenced Dr. Bramwell to three years of probation, including one year on house arrest.

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