Kirtis Green, a sales representative for Tennessee company Top Tier Medical, earned a 65 – month prison stint for his role in a $5 million health care fraud that saw several private health insurance companies, together with TriCare, duped into paying for medically unnecessary compounded creams. The charges against Green included Wire, Mail, and Health Care Fraud along with Identity Theft.
In an incredibly short period of time (March through December of 2014), Green recruited “customers” among those with health insurance coverage that would pay for compounded pain, wound, and scar creams. Those insurers, in particular Blue Cross/Blue Shield and TriCare, paid out millions for creams that were prescribed for individuals with no medical need for them.
Green and other Top Tier reps solicited the customers, collected their health care information and then acquired fraudulent prescriptions, either through physicians who prescribed without ever having seen any of the patients, or in the case of one Tennessee physician, by stealing her identity and DEA number and faxing over 90 prescriptions to a compounding pharmacy without her knowledge.
Top Tier earned a “commission” from the dispensing pharmacies who paid a percentage of the total cost of the cream (generally 30 – 40 percent) for each prescription submitted. Customers paid no co-pays and in some instances received a kickback for their participation in the form of a fee for a non-existent “evaluation” or “study.” The fees were minimal, often only $100 or $200, but of an amount sufficient to induce the customers to participate in the scheme.
Given the allegations and activities described in the indictment, it seems likely that Green’s is only the first head to roll in this fraudulent compounded medication scheme and that others will soon follow.