Bridget McCune takes plea deal in overall operation that uncovered false billings of nearly $1.3 billion across U.S.
There was a local connection to this week's nationwide operation into health care fraud and opioids scams when a Destin woman was among more than 400 people charged in false billings that totaled almost $1.3 billion.
Announced by the Department of Justice on Thursday, Attorney General Jeff Sessions called the collective action the “largest health care fraud takedown operation in American history” and said it indicates that some doctors, nurses and pharmacists “have chosen to violate their oaths and put greed ahead of their patients.”
Bridget McCune, 41, of Destin, was one of two sales representatives for a Haleyville, Alabama-based compounding pharmacy charged with participating in a conspiracy to generate prescriptions and defraud health care insurers and prescription drug administrators out of tens of millions of dollars in 2015.
“In this case, a pharmacy used a marketing scheme that increased sales of expensive medications without regard for patient need or medical necessity,” Acting U.S. Attorney Robert Posey stated in a news release. “Schemes like this defraud Medicare and other health insurance systems by pushing unnecessary medications and driving up the costs of health care.”
Named in separate indictments, McCune and Kelly Norris-Hartley, 41, of Tuscaloosa, Ala., were charged with conspiracy to commit health care fraud, wire fraud and mail fraud, according to a news release from the U.S. Attorney's Office for the Northern District of Alabama.
McCune and Norris-Hartley both represented Northside Pharmacy, an Alabama company that did business as Global Compounding Pharmacy, according to the release. The pharmacy did its prescription processing, billing and customer service at its “call center” in Clearwater.
The women were among 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in the fraud scheme uncovered by the Medicare Fraud Strike Force.
Of those charged, according to the release, more than 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in the nationwide arrests. In addition, the U.S. Department of Health and Human Services has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.
McCune is the wife of Dr. Mathew McCune with Dynamic Pain & Wellness, which is associated with Fort Walton Beach Medical Center and has offices in Fort Walton Beach, Destin, Crestview and Milton. Mathew McCune was welcomed in February 2016 to the staff at Fort Walton Beach Medical Center for Pain Management and Anesthesiology. His name is no longer included in the physicians listing on the hospital's website.
According to the release, Bridget McCune also is charged with conspiring to solicit and receive kickbacks in return for referring prescriptions under Medicare and TRICARE, a U.S. Department of Defense health care program, and with money laundering for spending proceeds of the crimes. McCune and Norris-Hartley face various counts of health care fraud for submitting fraudulent prescription reimbursement claims to Blue Cross Blue Shield of Alabama.
In conjunction with the charges announced Thursday, prosecutors also filed plea agreements with Norris and McCune.
“In this case, a pharmacy used a marketing scheme that increased sales of expensive medications without regard for patient need or medical necessity,” Posey said in the release. “Schemes like this defraud Medicare and other health insurance systems by pushing unnecessary medications and driving up the costs of health care.”
Global Compounding Pharmacy hired sales representatives, including Norris and McCune, who were located in various states and were responsible for generating prescriptions from physicians and other prescribers. To bill insurance providers, including Blue Cross Blue Shield of Alabama, Medicare and TRICARE, for these prescriptions, Global contracted to enter the pharmacy networks of their third-party administrators, known as “pharmacy benefit managers” or “PBMs." These PBMs included such outlets as CVS/Caremark.
The court documents describe a conspiracy at Global that centered on generating and billing PBMs for fraudulent, often high-reimbursement prescriptions. To generate prescriptions, Global hired sales representatives who were married or related to doctors and other prescribers. Global also encouraged sales representatives to volunteer at doctors’ offices where they would review patient files and push Global’s products to patients. Global executives also frequently instructed employees to obtain high-reimbursing prescriptions that Global would fill and bill for reimbursement.
Each of the plea agreements describes a Global executive instructing sales representatives to obtain certain prescriptions and, shortly after, Norris and McCune obtained those prescriptions for themselves and their dependents.
When billing, Global engaged in various fraudulent practices, including splitting drug quantities to evade PBM billing safeguards and automatically refilling and billing for prescriptions regardless of patient need. Global routinely waived co-pays to encourage patients to accept unnecessary medications and refills.
As part of their plea agreements, Norris and McCune agreed to forfeit money to the government as proceeds of illegal activity. McCune will forfeit $401,628 and Norris will forfeit $287,698.
In the terms of her plea agreement, McCune faces up to five years in federal prison and a fine of not more than $250,000 on one count of conspiracy to commit health care fraud, wire fraud and mail fraud. On five counts of health care fraud, she faces up to 10 years in federal prison and a fine of not more than $250,000. On two counts of engaging in monetary transactions in property derived from specified unlawful activity, she faces up to 10 years in federal prison and a fine of not more than $250,000.
Norris and McCune have both pleaded guilty and agreed to testify against others involved in exchange for the consideration of a reduced sentence, according to their plea agreements.
Global paid the defendants a base salary plus a monthly commission for prescriptions they obtained, according to court documents.
McCune began as a sales representative for Global’s Florida region in September 2014, working from Destin. Global promoted her to national field trainer in January 2015, but she also continued to function as a sales representative until leaving the company in July 2016. McCune had a “close familial relationship” with a Florida physician, according to her plea agreement. “The overwhelming majority of prescriptions she obtained” were issued under her family member’s signature, her plea agreement states.
Only identified as PRESCRIBER #5 in the plea agreement, the Florida physician with a “close familial relationship” was the primary issuer of prescriptions that rewarded McCune with profits of 7 percent from $0-$99,999 in billings, 10 percent from $100,000-$199,999 and 12 percent from $200,000-infinity.
Norris worked out of Tuscaloosa as a sales representative for Global’s Alabama region from August 2014 to July 2016. She was closely related to an Alabama physician. That relative and a second physician, described in her plea agreement as a family friend, wrote a significant number of the prescriptions Norris obtained for Global to fill.