Texas Compounding Kickback Schemers Sentenced

Four people have been sentenced to as long as five years in federal prison for their roles in a conspiracy to pay kickbacks in exchange for prescription referrals.
The four include John Ageudo Rodriguez, a former licensed pharmacist, who owned and operated Pharr Family Pharmacy, according to U.S. Attorney Nicholas J. Ganjei.
He conspired to pay kickbacks to medical providers who referred prescriptions to his pharmacy.
He then billed various benefit programs, including the Department of Labor, TRICARE and Medicare, for millions of dollars in claims.
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The Department of Justice has filed a complaint Aetna Inc. and affiliates, Elevance Health Inc. (formerly Anthem) and Humana Inc. alleging hundreds of millions of dollars in illegal kickbacks to brokers in exchange for enrollment in their plans.
Three large insurance broker organizations — eHealth, GoHealth and SelectQuote — were also included in the complaint.
The May 1 complaint alleges that the Medicare Advantage insurers paid illegal kickbacks to the brokers from 2016 to at least 2021.
The brokers then offered incentives to employees and agents to sell the plans to enrollees based on the kickbacks, according to the complaint.
They also allegedly established teams of insurance agents who would only sell the plans from the accused insurers.
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Optum is highlighting five medication management trends that are likely to impact workers’ compensation care over the next few years.
The pharmacy management firm’s annual analysis of transaction data shows that medication utilization trends are often driven by policy decisions and guideline adoption in various states, according to Tron Emptage, MA, RPh, Chief Clinical Officer.
At the top of the list is an expected decrease in opioid utilization and the rise of topical analgesic agents.
The number two trend is the expected rise in the number of prescriptions and higher claim costs resulting from comorbidities.
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