PENSACOLA, FLORIDA – A federal jury in Pensacola has convicted Andrew E. Fisher, 34, of Gulf Breeze, of conspiring to use his pharmacy to defraud more than $4.8 million from TRICARE, a federal health care program for uniformed service members, retirees, and their families, and then laundering the money generated by the fraud. The guilty verdict, reached by the jury on Monday, was announced today by Lawrence Keefe, United States Attorney for the Northern District of Florida.

"This conspiracy stole from taxpayers at the expense of the health and well-being of heroes who willingly served our nation or supported loved ones as they did so," said U.S. Attorney Keefe. "This is a flagrant and shocking violation of the public trust, and this conviction proves we will not allow such actions to continue."

Fisher, the owner and operator of Physician Specialty Pharmacy (PSP) in Pensacola, was convicted of conspiracy to commit health care fraud and wire fraud and conspiracy to commit money laundering. Evidence at trial established that between October 2014 and December 2015, Fisher conspired with sales representative Michael Scott Burton and others to defraud TRICARE out of more than $4.8 million in fraudulent claims for prescription compounded pain cream, scar cream, and wellness vitamins. Fisher agreed to fill prescriptions at PSP from a doctor’s office in Georgia whose beneficiary information was provided by Burton and individuals working for him, knowing that these particular beneficiaries had never seen that doctor and the prescriptions were not based on a legitimate doctor-patient relationship. In exchange for recruiting TRICARE beneficiaries to receive the prescriptions, Burton received approximately 50% of the amount paid to Fisher in insurance reimbursements. Those commission payments were laundered in the form of large wire transfers and direct deposits into Burton’s bank account in Georgia.

"I am pleased by the results of the investigative team and the U.S. Attorney's office to bring justice to these individuals," said Special Agent in Charge Cynthia A. Bruce of the Defense Criminal Investigative Service Southeast Field Office. "The defendant in this case conspired to deprive the DoD of precious resources needed for the healthcare of DoD Families."

Evidence at trial also established that as part of the scheme, Fisher, who is not a licensed pharmacist, directed his pharmacist employees to use ingredient formulations for the drugs that would maximize the amount his pharmacy could bill to TRICARE – which was upwards of $10,000 to $17,000 per medication at the time – and other insurance companies without considering what was best for patient care. Fisher also directed Burton and his employees to tell beneficiaries not to worry about co-payments, in order to ensure that the beneficiaries would not decline receiving the medications over out-of-pocket cost. Because PSP was not a TRICARE network pharmacy, Fisher paid Burklow Pharmacy in Pace a commission of approximately 15% to allow PSP to bill TRICARE using Burklow’s network provider contract for prescriptions received, filled, and shipped at PSP, including ones Fisher knew were fraudulent. During the conspiracy, Fisher also purchased Jay Pharmacy in Jay, Florida, and used its existing insurance contracts with TRICARE and others to bill for fraudulent PSP prescriptions.

Five co-conspirators named in the indictment, including Burton, previously pled guilty in two related cases. Burton was sentenced to 96 months in prison, Bradley D. Pounds was sentenced to 21 months in prison, and Marie Ann Smith and Heather E. Pounds were sentenced to probation. Brad T. Hodgson is still awaiting sentencing. Fisher’s sentencing has been set for May 22, 2020, at 10:00 a.m.

Assistant United States Attorney Alicia H. Forbes prosecuted the case following a joint investigation by the Federal Bureau of Investigation, Defense Criminal Investigative Service, Florida Department of Law Enforcement, Florida Department of Financial Services-Bureau of Insurance Fraud, Florida Department of Health, Naval Criminal Investigative Service, and Army Criminal Investigative Command.

The United States Attorney’s Office for the Northern District of Florida is one of 94 offices that serve as the nation’s principal litigators under the direction of the Attorney General. To access public court documents online, please visit the U.S. District Court for the Northern District of Florida website. For more information about the United States Attorney’s Office, Northern District of Florida, visit http://www.justice.gov/usao/fln/index.html.

The year 2020 marks the 150th anniversary of the Department of Justice. Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.

 

PENSACOLA, FLORIDA – Michael Scott Burton, 52, of Decatur, Georgia, was sentenced to 96 months in federal prison yesterday after he pleaded guilty to charges of conspiracy to commit health care fraud and wire fraud, conspiracy to commit money laundering, and money laundering. The sentence was announced today by Lawrence Keefe, United States Attorney for the Northern District of Florida.

Between January 2014 and December 2015, Burton conspired with others to defraud TRICARE and other insurance companies out of more than $6.5 million in fraudulent claims for prescriptions for compounded pain cream, scar cream, and wellness capsules. Burton agreed that co-defendant Brad T. Hodgson would forge prescriptions for compounded drugs for individuals who Burton knew were not patients of the Georgia doctor’s practice where Hodgson worked. Burton recruited sales representatives, including co-defendants Bradley D. Pounds and Heather E. Pounds, to obtain and provide Burton with the personal identifying information and insurance cards of individuals for whom the prescriptions could be issued in exchange for commission payments. Burton would forward that information to Hodgson, who would issue the prescriptions – even though he was not licensed to write prescriptions – and send them to Physician Specialty Pharmacy in Pensacola without the individuals ever seeing or speaking with a doctor. Burton also recruited co-defendant Marie Ann Smith to assist Hodgson with processing and submitting prescriptions. Physician Specialty Pharmacy then caused TRICARE and other insurance companies to be billed and paid Burton a 50% commission for each compounded drug prescription that was paid by insurance. By this conduct, Burton earned over $1.4 million in commissions from fraudulent prescriptions.

"Health care fraud is a crime that affects all Americans – but to perpetrate a scam that victimizes a program for our nation’s service members and their families is beyond appalling," Keefe said. "This conspiracy stole money meant to help those who have given so much to our nation, and the criminals behind it deserve the punishment they receive."

"The wide-spread corruption uncovered in this complex and multistate fraud scheme wasted millions of American taxpayer dollars, and furthermore, deprived U.S. military members and their families of legitimate prescription medications and other needed medical care," said Cynthia A. Bruce, Special Agent in Charge, DCIS-Southeast Field Office. "DCIS is committed to working with our investigative partners and the U.S. Attorney's Office to identify, investigate and bringing to justice anyone who defrauds the DoD and the American taxpayer."

For his role in the scheme, Burton was sentenced to 96 months in prison. He was also ordered to pay $$6,540,348.48 in restitution to TRICARE and pay a forfeiture money judgment of $1,480,931.74. In February, Bradley Pounds was sentenced to 21 months in prison, and Smith and Heather Pounds were sentenced to probation. In separate related cases, Hodgson is awaiting sentencing after pleading guilty, and Andrew E. Fisher, the president and part-owner of Physician Specialty Pharmacy, is awaiting trial scheduled for September 3rd.

"Crimes like this increase the costs we all pay for healthcare and prescription drugs," said FDLE Commissioner Rick Swearingen. "I thank our FDLE Pensacola office for spearheading this complex investigation and our U.S. Attorney’s Office for prosecuting this case."

Assistant United States Attorney Alicia H. Forbes prosecuted these cases following an investigation by the Federal Bureau of Investigation, Defense Criminal Investigative Service, Florida Department of Law Enforcement, Florida Department of Financial Services-Bureau of Insurance Fraud, Florida Department of Health, Naval Criminal Investigative Service, and Army Criminal Investigative Command.

The United States Attorney’s Office for the Northern District of Florida is one of 94 offices that serve as the nation’s principal litigators under the direction of the Attorney General. To access public court documents online, please visit the U.S. District Court for the Northern District of Florida website. For more information about the U.S. Attorney’s Office, Northern District of Florida, visit https://www.justice.gov/usao-ndfl

 

PENSACOLA, FLORIDA – Andrew E. Fisher, 33, of Gulf Breeze, Florida, was arraigned yesterday in the U.S. District Court in Pensacola after a federal grand jury returned an indictment charging him with conspiracy to commit health care fraud and wire fraud and conspiracy to commit money laundering. The indictment was announced by Lawrence Keefe, United States Attorney for the Northern District of Florida.

The indictment alleges that between October 2014 and December 2015, Fisher, the president and part-owner of Physician Specialty Pharmacy, conspired with others to defraud TRICARE and other insurance companies through more than $4.8 million in fraudulent claims for prescriptions for compounded pain cream, scar cream, and wellness capsules. According to the indictment, Fisher agreed to fill prescriptions at his pharmacy knowing they were not based on legitimate doctor-patient relationships. In exchange, Fisher allegedly paid commissions to the marketing representatives who recruited individuals to receive the compounded drug prescriptions. Fisher, who is not a licensed pharmacist, also allegedly directed his employees to use ingredient formulations for the drugs that would maximize the amount his pharmacy could bill to TRICARE and other companies, without regard to what was medically necessary.

Five co-conspirators named in the indictment have previously pleaded guilty in two related cases. Bradley D. Pounds was sentenced to 21 months in prison, and Marie Ann Smith and Heather E. Pounds were sentenced to probation. Michael Scott Burton and Brad T. Hodgson are awaiting sentencing.

The maximum penalty for conspiracy to commit health care fraud and wire fraud is 20 years imprisonment, and the maximum penalty for conspiracy to commit money laundering is 10 years imprisonment. Fisher’s trial is scheduled for September 3, 2019, at 9:00 a.m. at the United States Courthouse in Pensacola.

Assistant United States Attorney Alicia H. Forbes is prosecuting the case following an investigation by the Federal Bureau of Investigation, Defense Criminal Investigative Service, Florida Department of Law Enforcement, Florida Department of Financial Services-Division of Insurance Fraud, Florida Department of Health, Naval Criminal Investigative Service, and Army Criminal Investigative Command.

An indictment is merely an allegation by a grand jury that a defendant has committed a violation of

federal criminal law and is not evidence of guilt. All defendants are presumed innocent and

entitled to a fair trial, during which it will be the government’s burden to prove guilt beyond a

reasonable doubt at trial.

The United States Attorney’s Office for the Northern District of Florida is one of 94 offices that

serve as the nation’s principal litigators under the direction of the Attorney General. To access

public court documents online, please visit the U.S. District Court for the Northern District of

Florida website.  For more information about the U.S. Attorney’s Office, Northern District of

Florida, visit http://www.justice.gov/usao/fln/index.html.