The Department of Justice has filed a complaint against a Houston-based company for falsely inflating pharmaceutical ingredient prices to over 400 times the actual cost for the purposes of defrauding TRICARE, a federal health care program. According to a press release on Nov. 8, the DOJ filed the complaint under the False Claims Act against Professional Compounding Centers of America Inc. (PCCA), for blowing up Average Wholesale Prices (AWPs) of pharma ingredients that are used in compound drugs. After purchasing ingredients from PCCA, compounding pharmacies would then submit these inflated prices for reimbursements from TRICARE. Suppliers like PCCA establish and report the AWPs for ingredients to pricing compendia used by health care programs like TRICARE and insurance companies. TRICARE provides insurance for active-duty military personnel, military retirees, and military dependents. Based partially on the reported AWPs, TRICARE would calculate the amounts of reimbursements distributed to pharmacies. According to the report, …
Texas Pharma Company Inflated Prices Over 400 Times Above Cost to Claim Fraudulent Reimbursements: DOJ
November 9, 2021
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