U.S. ex rel. Silva v. Vici Mktg., LLC

361 F. Supp. 3d 1245
CourtDistrict Court, M.D. Florida
DecidedFebruary 13, 2019
DocketCase No. 8:15-cv-444-T-33TGW
StatusPublished
Cited by7 cases

This text of 361 F. Supp. 3d 1245 (U.S. ex rel. Silva v. Vici Mktg., LLC) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
U.S. ex rel. Silva v. Vici Mktg., LLC, 361 F. Supp. 3d 1245 (M.D. Fla. 2019).

Opinion

VIRGINIA M. HERNANDEZ COVINGTON, UNITED STATES DISTRICT JUDGE

This matter comes before the Court upon consideration of Defendants Larry Smith, Stat Direct, LLC, and Z Stat Medical, LLC's Motion to Dismiss the United States of America's Complaint in Intervention (Doc. # 76), filed on December 24, 2018. The United States responded on January 25, 2019. (Doc. # 86). For the reasons that follow, the Motion is granted in part and denied in part.

I. Background

Relators Jennifer Silva and Jessica Robertson initiated this False Claims Act (FCA) action under seal in March of 2015. (Doc. # 1). Relators' Complaint alleged that all Defendants - VICI Marketing, LLC, VICI Marketing Group, LLC, Z Stat Medical, Stat Direct, Anthony Crowe, Vinson Di Santo, Jude Germain, Marjorie Lantum, Medvest LLC, Naveed Naeem, Scott Roix, and Smith - violated the FCA by "seeking payment at greatly inflated rates for lidocaine" and "submitting fraudulent claims for payment to government healthcare programs including Tricare, Medicare and Medicaid." (Id. at 1-2).

Three years later, on August 10, 2018, the United States elected to intervene for the claims against VICI Marketing, VICI Marketing Group, Roix, Z Stat Medical, Stat Direct, and Smith, and filed a Complaint in partial intervention. (Doc. ## 24, 39). The United States has settled its claims against Roix and the VICI Defendants. (Doc. # 38). The United States is now pursuing its claims against Smith, Z Stat Medical, and Stat Direct alone.

In its Complaint in partial intervention, the United States alleges that Smith, Z Stat Medical, and Stat Direct participated in two kickback schemes.

A. Centurion Scheme

First, the United States alleges that "from September 2014 to February 2015, [ ] Smith via [ ] Z Stat Medical ... knowingly submitted and/or caused the submission of claims to TRICARE for reimbursement for compounded drugs that were false or fraudulent because they were tainted by kickbacks to marketers." (Doc. # 39 at 2). Z Stat Medical, which does *1249business as Oldsmar Pharmacy, "is a compounding pharmacy that was owned during the relevant time by [ ] Smith." (Id. at 9). Z Stat Medical "was registered as being managed by Stat Direct" and "advertised itself as the specialty compounding division of Stat Direct." (Id. at 3).

According to the Complaint in partial intervention, "[i]n November 2014, [Z Stat Medical] entered into a kickback arrangement with Centurion Compounding, Inc. [ ] under which [Z Stat Medical] and Centurion agreed to split the profits of TRICARE prescriptions in exchange for referrals." (Id. at 9). "Centurion ... engage[d] sales representatives as independent contractors to market expensive compounded medications, specifically creams for pain and scars, among others, to beneficiaries of healthcare plans, especially TRICARE." (Id. at 10-11). "Centurion continued to direct [both] the patients that Centurion sales representatives had recruited and the physicians in their network to send all of their compounded cream prescriptions to Centurion, which then transmitted them to [Z Stat Medical] to fill." (Id. ).

"Smith and other employees of [Z Stat Medical] negotiated with Anderson, co-owner of Centurion, the commission that [Z Stat Medical] would pay to Centurion per prescription that Centurion referred to [Z Stat Medical]." (Id. at 11). They ultimately agreed that Z Stat Medical would take fifteen percent of the profits off the top, and then the remaining eighty-five percent of the profits would be split 50-50 between Z Stat Medical and Centurion. (Id. ).

Z Stat Medical and Centurion maintained "commission reports" - spreadsheets listing "all of the prescriptions generated by Centurion, the amounts received by [Z Stat Medical] for claims that the pharmacy submitted to the patients' insurance for reimbursement, and the amounts owed in commission, thereby documenting the kickback arrangement." (Id. ). "[T]he commission report for December 1, 2014 through December 15, 2014 identified over $9,700,000 received by [Z Stat Medical] and over $3,500,000 in commissions owed to Centurion." (Id. ).

"[T]he vast majority of prescriptions from federal beneficiaries were submitted to TRICARE." (Id. ). From November 2014 to February 2015, Z Stat Medical submitted over 4,000 claims to TRICARE "for compounded prescriptions that Centurion arranged for [Z Stat Medical] to fill in exchange for commissions on each prescription." (Id. at 12). "TRICARE paid approximately $18,000,000 for those prescriptions." (Id. ).

During this kickback scheme, Z Stat Medical and Centurion "sought the assistance of attorneys to try to create a legally permissible arrangement whereby the relationship between Centurion and [Z Stat Medical] could continue and the individual marketers could be compensated on a commission basis." (Id. ). Although they never reached such an arrangement, the kickbacks continued. (Id. ).

In total, Z Stat Medical paid over $6,000,000 in commissions to Centurion from November 2014 to February 2015. (Id. ). "Centurion then disbursed to its independent contractor sales representatives their share of the commissions for the prescriptions they generated." (Id. ). "The only work the Centurion marketers performed in exchange for the commissions was to generate prescriptions that went to [Z Stat Medical]." (Id. at 13). Because the marketers were independent contractors, Z Stat Medical "did not control how the marketers generated the prescriptions that were sent to the pharmacy and did not supervise the marketers." (Id. ). "Smith, President of [Z Stat Medical], knew that the money paid to Centurion was used to pay commissions to the marketers, *1250who were not employees of [Z Stat Medical] or Centurion." (Id. at 12).

"The United States executed a search warrant on [Z Stat Medical] and others on February 10, 2015. On February 13, 2015, [the Defense Health Agency] sent a letter to Smith suspending payments for present and future claims from [Z Stat Medical]." (Id. at 13).

B. Roix Scheme

Smith and Z Stat Medical allegedly entered a separate kickback agreement with Roix, whereby Roix's companies would send prescriptions to Z Stat Medical. (Id. ). "Companies associated with Roix, including Health Saving Solutions, would publish online advertisements offering free consultations for pain creams. Customers would call the number listed in the advertisement and speak with telemarketers at Vici Marketing, a call center company owned by Roix." (Id. ).

Customers with insurance that would cover compounded medicines would be connected to a telemedicine company, and the doctor would prescribe compounded medications without seeing the customers. (Id. at 14). "The resulting prescription would go to one of Roix's companies, who would then send the prescription to [Z Stat Medical] to fill." (Id. ).

"[Z Stat Medical] would submit a claim for reimbursement to private payors and federal health care programs and then include the amount of the reimbursement in the next commission payment to Health Saving Solutions." (Id. ).

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Bluebook (online)
361 F. Supp. 3d 1245, Counsel Stack Legal Research, https://law.counselstack.com/opinion/us-ex-rel-silva-v-vici-mktg-llc-flmd-2019.