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Troy woman indicted in pharmaceutical fraud scheme

A Troy woman is one of 10 Alabama and Florida people indicted Monday on federal charges in a $200 million prescription drug fraud case.

The indictment stems from a case involving Northside Pharmacy, doing business as Global Compounding Pharmacy. A total of 103 indictments were presented among employees of the company, including 12 charges against Lisa Holmes, 40, of Troy, who prosecutors described as a district manager supervising sales representatives.

The indictment charges them with fraudulently billing health care insurers and prescription drug administrators for over $200 million in prescription drugs.  In one listed instance, the defendants’ fraudulent conduct caused a prescription plan administrator to pay over $29,000 for one tube of a cream advertised as treating “general wounds.”

“Motivated by greed, the defendants executed a brazen health care fraud conspiracy and scheme that cost health insurance plans, including those that protect the elderly, disabled, military members and veterans, millions of dollars,” said U.S. Attorney Jay E. Town. “Their scheme deprived health insurance plans of money that could have gone to assist patients with real medical needs.  To date, this investigation has resulted in 28 people being charged.  Would-be healthcare fraudsters should be on notice that our Office is dedicated to rooting out this conduct.  We applaud the investigative agencies for their hard work.”

The indictment describes a multi-faceted health care fraud and mail fraud conspiracy and scheme in which the defendants billed for medically unnecessary drugs.  Aspects of the scheme included paying prescribers to issue prescriptions; directing employees to get medically unnecessary drugs for themselves, family members, and friends, to be filled and billed by Global and other related pharmacies; altering prescriptions to add non-prescribed drugs including controlled substances such as Tramadol and Ketamine; automatically refilling prescriptions—often as many as 12 times—regardless of patient need; routinely waiving and discounting co-pays to induce patients to obtain and retain medically unnecessary drugs; and billing for drugs without patients’ knowledge and hiding that conduct from patients by mailing the drugs to (owner) John J. Adams’ home.

The indictment states that the defendants targeted multiple health insurance plans, including Global’s, Blue Cross Blue Shield of Alabama, and plans providing health insurance to the elderly, disabled, members of the military, and veterans—Medicare, TRICARE, and CHAMPVA, among others.

The maximum penalty for healthcare and mail fraud conspiracy is 20 years in prison and a $250,000 fine. The maximum penalty for health care fraud is 10 years in prison and a $250,000 fine.  The maximum penalty for mail fraud is 20 years and a $250,000 fine.