This transcript has been auto generated
00;00;00;00 - 00;00;22;13
Jonathan Porter
Welcome to another episode of Husch Blackwell's False Claims Act Insights podcast. I'm your host, Jonathan Porter. I follow the false claims action format pretty closely. I read the DOJ press releases, the public statements by DOJ officials. The key teams that come out from under Steele, I read all of those, and I try to distill everything and spot any trends.
00;00;22;16 - 00;00;46;03
Jonathan Porter
One trend that I've noticed recently, and it's one that I think will endure. Is FCA Enforcement Against Pharmacy's pharmacies have unique issues under FCA. Years ago, when I was a new federal prosecutor, I remember talking with HHS OIG agents about pharmacy enforcement, and I naively said something like, we have a pharmacies. They just build things that doctors prescribe.
00;00;46;04 - 00;01;06;11
Jonathan Porter
How can they get in trouble for that? And I was laughed at and quickly disabused of that impression. Pharmacies. They're in a tough spot right now. Reimbursement rates for drugs are not where pharmacies really want them to be. Foot traffic for retail pharmacies is down, and more and more people are moving to online pharmacies with these basic financial pressures.
00;01;06;13 - 00;01;30;20
Jonathan Porter
Pharmacies are looking for ways to be more profitable, and that sometimes has some real compliance risks. To add to those compliance risks is the fact that pharmacies handle potentially deadly opioids, which Attorney General Pamela Bondi has announced are an enforcement priority for her Justice Department. Given all of this, I thought we should do a whole podcast episode on FCA enforcement Against Pharmacies.
00;01;30;22 - 00;01;56;14
Jonathan Porter
Joining me today to talk about enforcement against pharmacies is my Hush Blackwell colleague, Abe Souza. Regular listeners may remember Abe from our episode earlier this year called some FCA whistles are Louder Than others where Abe and I broke down DOJ FCA statistics. We talked about how to work with AUSA during investigations. Abe is a former AUSA from the Northern District of Illinois and now at Husch.
00;01;56;16 - 00;02;07;03
Jonathan Porter
Abe helps clients with all manner of federal investigations. And so, Abe, welcome back to the podcast, and thanks for telling our listeners a little bit about how FCA enforcement impacts pharmacy.
00;02;07;10 - 00;02;10;04
Abe Souza
Hey, Jonathan, this is great. Thanks for having me back.
00;02;10;07 - 00;02;35;13
Jonathan Porter
So given Pamela Bondi's focus on opioids, we should probably start by talking about how pharmacies can get in trouble for things involving opioids. So historically when we're talking about opioids, we're typically talking about civil penalties under the Controlled Substances Act. But in some high profile cases recently Abe DOJ has used the False Claims Act as well. Abe, why don't you start us off by telling our listeners why and how that is?
00;02;35;15 - 00;03;07;09
Abe Souza
That's exactly right, Jonathan. This is a really fascinating area. As you alluded to, DOJ and the Drug Enforcement Administration or DEA have broad authority under the controlled substances Act. But the civil penalty model under the Controlled Substances Act isn't nearly as fleshed out as it is under the False Claims Act. And so basically, the Controlled Substances Act provides for a maximum fine, but there's no minimum floor in terms of civil penalty for a violation.
00;03;07;09 - 00;03;33;12
Abe Souza
And because of that, and also because of other ambiguities in the statutory scheme, frankly, there's a lot of uncertainty for DOJ in terms of how courts would impose penalties or particular violations. But as we know here at Husch Blackwell, that is not the case with the False Claims Act, which provides a clear enforcement mechanism involving very significant damages and penalties.
00;03;33;12 - 00;04;01;22
Abe Souza
And in the context of pharmacies, which is our focus here, claims made to federal health care programs like Medicare, Medicaid, Tricare that violate the Controlled Substances Act are considered false claims, and the consequences for that are very significant in terms of three times the damages, what we call treble damages in per claim penalties, which are adjusted annually for inflation and the penalties depend on the timing of the violation and the date they're assessed.
00;04;01;22 - 00;04;27;29
Abe Souza
But the current range is between about $14,000 and almost $29,000 per claim. So this is a very significant, some might say, draconian enforcement regime with clear consequences and expectation for DOJ. And I think, Jonathan, that's why you're seeing DOJ rely on the False Claims Act in this context, rather than sticking solely with civil penalties under the Controlled Substances Act.
00;04;28;01 - 00;04;50;06
Jonathan Porter
Thanks, Amy. I appreciate that. Yeah. No, I think you're exactly right. It's helpful background, and I think you're exactly right. DOJ is tools and leverage when they're dealing with the False Claims Act is substantially higher than when they're just dealing with the Control Substances Act. I think when you're dealing with the Controlled Substances Act, uses and DOJ trial attorneys, they have this fear that we're going to try this case.
00;04;50;06 - 00;05;13;20
Jonathan Porter
We can get all the way to the end. A judge is going to slap them on the wrist. But that doesn't really happen when you're dealing with the False Claims Act because you've got these, you know, concrete penalties structure this concrete treble damages structure. And so I think when DOJ can they're going to operate under the False Claims Act and not necessarily just go under the Controlled Substances Act, even though the Controlled Substances Act is the sort of clearer fit.
00;05;13;22 - 00;05;41;15
Jonathan Porter
But that's really helpful background. And I think there's two cases in particular that DOJ brought under the FCA recently against pharmacies, and these are against big pharmacies, and they've been widely reported one against Walgreens and the other against CVS. Both of these complaints have got very similar allegations, corporate policies that discouraged their, you know, retail pharmacies from checking for red flags to tell our listeners about those two cases and what the pharmacy industry can learn from them.
00;05;41;18 - 00;06;02;22
Abe Souza
Yeah, these are extremely interesting cases and big news in our world. Jonathan and my former office, the U.S. Attorney's office in Chicago, the Northern District of Illinois, had a lead role in the Walgreens case. So I will stick closely to the publicly available record here. But as you said, there are two cases, one against CVS and one against Walgreens.
00;06;02;24 - 00;06;27;19
Abe Souza
The CVS case was filed in federal court in Rhode Island at the end of last year. And the government's complaint, the Walgreens case was filed earlier this year in my own district, the Northern District of Illinois, and it consolidated four separate key tabs into one government enforcement action. But the cases involved the same types of allegations against these major national pharmacy chains.
00;06;27;19 - 00;07;17;22
Abe Souza
And as you alluded to, Jonathan, the allegation is that CVS and Walgreens failed to spot obvious red flags that should have alerted them that opioid prescriptions were improper and worse than that, implemented corporate policies that really exacerbated and contributed significantly to the problem. So to give the listeners some examples from the CVS case, DOJ allege that CVS based pharmacies compensation on the number of filled prescriptions that CVS implemented, policies that pressured pharmacists to fill prescriptions quickly, and, relatedly, that CVS also based compensation on customer satisfaction surveys, which again led pharmacists to fill prescriptions quickly without taking the time to spot red flags.
00;07;17;24 - 00;07;44;04
Abe Souza
Now, in terms of what the red flags were that the pharmacists and the pharmacies ultimately failed to appreciate, the complaints identified prescriptions for excessive quantities of opioids, prescriptions for what's a particularly dangerous combination of drugs known as the trinity, prescriptions for other dangerous drug combinations, early refills and many other issues as well. In terms of where these cases are.
00;07;44;04 - 00;08;11;19
Abe Souza
In April, Walgreens agreed to pay $300 million to resolve the allegations, which is obviously a big sum. The settlement it's based on, Walgreens ability to pay in Walgreens will actually owe the government an additional 50 million if the company is sold or merged or transferred in the next seven years or so prior to 2032. The CVS case is ongoing, and the motion to dismiss is being brief now, and it's going to be really interesting to see what happens.
00;08;11;19 - 00;08;41;15
Abe Souza
But regardless of how it turns out, Jonathan, I think the message is loud and clear here that pharmacies need to be very careful in this space and make a significant investment in compliance, and they need to be there guarding against not only the compliance problems that arose in these cases, but other potential pitfalls as well. And critically, I think pharmacies need to make sure that they have policies in place that allow pharmacists the time they need to notice and reject improper prescriptions.
00;08;41;15 - 00;09;03;08
Abe Souza
That's really what seems to be driving these cases. Any time you are trying to pursue a policy that could be construed as pressuring pharmacists to move more quickly, rush in filling these prescriptions, that's going to be a problem. And the potential consequences for something like that are very significant, as you see in these two cases.
00;09;03;14 - 00;09;25;08
Jonathan Porter
Thanks, Abe. That's great. Yeah. No, I think you're exactly right. Thinking about compliance here is really important. And when you're thinking about what pharmacists job is, it's not just the dispense. The thing that's been prescribed is to check to make sure that the prescription is valid. The concept of a corresponding responsibility is a very real one to DEA and DOJ.
00;09;25;10 - 00;09;52;13
Jonathan Porter
And so when you're implementing policies at a corporate level, they're going to discourage retail pharmacists from doing their job. You've got a big problem when we think about what retail pharmacists are doing. That's how you turn isolated incidents into a big corporate problem. And so for those who are operating chain retail pharmacies, they've got to think about how their corporate policies are impacting their people, but also on the more, you know, singular level.
00;09;52;16 - 00;10;14;08
Jonathan Porter
Just make sure that your pharmacists are actually doing their checks. There are a number of things. If all of a sudden you look up and you realize, oh, 50% of my controlled substance spills are all for this one provider and that provider is 70 miles, then you've probably got a big problem there with how DOJ is going to view your obligations under your corresponding responsibility.
00;10;14;16 - 00;10;29;23
Jonathan Porter
And I think given the attorney general's focus on opioids, those cases are going to come. They've been there in the past. I think that they're going to come back around. And so, Abe, appreciate you starting this conversation by telling our listeners about opioids. And I think it's clear that pharmacies, they've got to tread carefully when opioids are involved.
00;10;29;25 - 00;10;55;00
Jonathan Porter
But there are other ways pharmacies can get in trouble under the False Claims Act. And one of those has to do with math counting medicine coming in and then comparing that against medicine in the pharmacies claiming. So this is an investigation tactic that DEA and DOJ keep using, and pharmacies keep getting in trouble for it. So, Abe, tell our listeners about these cases where DOJ is really just looking at what's coming in and what you're claiming.
00;10;55;02 - 00;11;27;24
Abe Souza
Thanks, Jonathan. Yeah, this is pretty straightforward from DOJ, but also innovative and insightful at the same time, which are not always words we associate with the federal government. Basically, what DOJ and DEA have been doing is simply mashing up the claims received by federal health care programs like Medicare Part D, for example, and then comparing that to what the pharmacy is ordered from suppliers and what that shows is whether the pharmacy billed for drugs now dispensed.
00;11;27;27 - 00;11;56;18
Abe Souza
You know, in the scheme of things, these are really easy cases for DOJ to replicate going forward. And to give you an example, there was a settlement out of the US Attorney's office in new Jersey earlier this year. I believe it was handled jointly with Maine Justice, where a pharmacy agreed to pay $50,000, pretty significant sum to resolve allegations that it had violated the false claims Act by billing federal health care programs for medications that were were never even dispensed.
00;11;56;20 - 00;12;25;08
Abe Souza
And the government, interestingly, indicated that it figured this out through inventory records, and specifically that the records showed that the pharmacy did not purchase enough of the medications from wholesalers to fill the prescriptions that were then billed to Medicare Part D. So again, that's a straightforward investigative technique that resulted in a solid payout. And Jonathan, we talked about this last time I was on.
00;12;25;08 - 00;12;52;11
Abe Souza
But DOJ is all about efficiency and preserving resources USA you and DOJ trial attorneys have a lot on their plate. And so if you can use something like this, a fairly straightforward investigative technique, and obtain a sizable settlement under the False Claims Act, that's all to the good. From the government's perspective and just saves a lot of time while also holding potential wrongdoers accountable.
00;12;52;11 - 00;13;00;19
Abe Souza
And I would really look for DOJ and DEA to continue to utilize this approach going forward, given their track record of success so far.
00;13;00;22 - 00;13;19;17
Jonathan Porter
Yeah, Abe, I agree with you there. I think this is something you're going to see more of because as you said, DOJ is trying to get better with their data. And one thing that I think DOJ could do, and I don't believe DOJ was doing this when I was there, maybe they were before you left is going to the wholesalers and saying, look, tell us everything that you've given.
00;13;19;17 - 00;13;41;07
Jonathan Porter
All the pharmacies, give us a spreadsheet of everything that you're giving pharmacies for these high dollar drugs, and then you can match that up against your records from PBMs and say, all right, here's some red flags. Here's some things that really don't make sense. Let's go send kids to all of these pharmacies where we're seeing a discrepancy, where we're seeing more claimed than whatever the thing is that goes out.
00;13;41;07 - 00;13;59;26
Jonathan Porter
I mean, PBMs pay a lot of money for particular types of drugs, inhalers and the like. I would be surprised if at some point DOJ doesn't start doing that and they may already be doing it. I just wasn't aware. But that's the sort of thing the DOJ is going to continue to do is to get smart with their data and figure out how do we spot these, like, glaring issues.
00;13;59;26 - 00;14;15;15
Jonathan Porter
And so I'm glad we talked about this, because that's something I could see happening more and more. And so if you're a pharmacy and you are claiming that you're dispensing a lot of stuff, but you're not ordering it, you got a problem, don't do that. I think that's something that DOJ is going to be able to catch pretty easily.
00;14;15;18 - 00;14;38;07
Jonathan Porter
So another topic to discuss it keeps happening as well, which is pharmacies that get involved in aggressive marketing campaigns involving high reimbursement drugs. Years back you saw these extreme compounding pharmacy cases involving Tricare. For whatever reason, Tricare was behind the rest of the payers in terms of shutting off a bunch of expensive compounding codes in more recent years.
00;14;38;07 - 00;14;57;01
Jonathan Porter
There are cases involving expensive creams, foot baths, but I've heard variations on this recently. And for pharmacies who very badly want to get involved in dispensing high reimbursement drugs, Abe, tell tell our listeners what they should be thinking about. Both on the marketing risk side and on the enforcement side.
00;14;57;03 - 00;15;27;01
Abe Souza
Dana. Well, kudos to you, Jonathan, for doing this episode because there are so many interesting developments in this space. So obviously other traditional pharmacy model a patient comes in with a prescription, prescription gets filled. Things have gotten much more complex than that over time. And what you see now is that many pharmacies engage marketers to market their services to patients, including, of course, beneficiaries of federal health care programs.
00;15;27;01 - 00;15;58;20
Abe Souza
And we could probably spend a ton of time on this, Jonathan, and talking through potential risks and concerns. But in terms of issue spotting, the big thing that jumps off the page right away is the anti kickback statute, which generally prohibits making payments to induce referrals. And that is a huge risk of arrangements like this one, where pharmacies use marketers, especially when the arrangement involves high reimbursement drugs that are likely to catch the attention of DOJ.
00;15;58;20 - 00;16;19;01
Abe Souza
I think one fundamental principle is that high dollars equates to high risk. And so if the marketing arrangement involves these kind of high reimbursing medications, you could very well see DOJ scrutiny fairly quickly. Now, I think it's important to say that some pharmacies are able to make this marketing model work through compliance with a safe.
00;16;19;01 - 00;16;20;00
Jonathan Porter
Harbor.
00;16;20;02 - 00;16;48;14
Abe Souza
Under the anti kickback statute, which is a little bit technical. But I think the bottom line is that if you have any relationship in healthcare where referrals or anything like that are being monetized, you really need to thoroughly scrutinize those arrangements and make sure they comply with the law. And the risk of doing so is significant. And you very well may have a big problem if you haven't thoroughly vetted your arrangements.
00;16;48;16 - 00;17;06;14
Jonathan Porter
Thanks, Abe. Yeah, I think you're right. The higher the dollars go up, the more the risk goes up. I think that's sort of a takeaway that we could have for this entire episode. But here, there are some legitimate ways that you can have some marketers, like you said, you've got to make sure that you're meeting a safe harbor or you will get in a lot of trouble.
00;17;06;16 - 00;17;26;17
Jonathan Porter
There are a lot of pharmacies who take that way too far, and they've gotten in trouble for it. I think if you're a pharmacy and you want to pick the product first and then find patients that could receive it, I just think regulators and enforcers are going to view that as, I don't know, this is the way the system is supposed to work, but there are ways that you can do it.
00;17;26;17 - 00;17;49;28
Jonathan Porter
I'm not saying that you can't do it. There are ways to do it, but you've got to understand what your risks are. And so looping in some health care regulatory compliance attorneys on the front end seems like the way I would do things. And I hope pharmacies are doing that on their own. So because like you said, the enforcement risk there could be tremendous because like we said, when we're dealing with high dollars, there's a lot of scrutiny that comes with that.
00;17;50;01 - 00;18;16;18
Jonathan Porter
So let's cover one last example. And to me, it's the most extreme example of those, you know, variety of cases that you were discussing just then. This is a recent criminal case in Kentucky where a pharmacist named Justin Bell was sentenced to four months in federal prison for dispensing medicated pads that DOJ argued were not medically necessary. Four months is not like the longest sentence that you see in the healthcare world, but I certainly wouldn't want to do four months in a federal prison.
00;18;16;18 - 00;18;30;21
Jonathan Porter
So to me, this is a big deal. So, Abe, tell our listeners about this case. Tell our listeners how Mr. Bell found himself criminally charged over medicated pads and how other pharmacists and pharmacy owners can avoid Mr. Bell's fate.
00;18;30;27 - 00;18;53;05
Abe Souza
Absolutely. So, Jonathan, like you, anytime I hear about criminal enforcement, my ears perk up and we want to pay attention pretty closely because unlike a false Claims Act settlement or judgment, which can be very significant, as we know, prison time is a whole nother matter. And so we really want to be attuned to what DOJ is doing in the criminal health care fraud context.
00;18;53;07 - 00;19;18;12
Abe Souza
So according to Bell's plea agreement, he was a pharmacist who owned and operated a pharmacy in Kentucky. And the pharmacy dispensed a variety of prescriptions, including, as relevant here, medicated pads that you mentioned that manage and prevent scars from burns and other traumatic skin injuries. And back to our point, about high dollar equals high risk. These scar pads were expensive.
00;19;18;16 - 00;19;44;17
Abe Souza
Kentucky Medicaid paid about $14,000 for a box of 12. So these are not cheap. And Bell began to solicit unwitting Kentucky Medicaid patients to receive the scar pads, even though the patients didn't have a medical need for them. And in some cases, patients received the pads without discussing them with their doctor or even using them at all. So these are pretty egregious facts.
00;19;44;17 - 00;20;23;13
Abe Souza
But he was charged for submitting just eight claims to Medicaid, even though it's only eight claims. Again, the dollars were high, totaling just about $118,000. And I think this criminal charge shows you how seriously DOJ takes this, even if the number of claims is low in terms of takeaways. Again, high dollars is high risk when you're dealing with really expensive medications or therapies, you're going to get the attention of regulator ERS and DOJ and federal prosecutors and pharmacies, again, are inviting a lot of risk if they try to convince a doctor to prescribe a particular medication.
00;20;23;13 - 00;20;27;04
Abe Souza
But particularly if it's something that's very expensive.
00;20;27;07 - 00;20;44;29
Jonathan Porter
Things say, yeah, this particular case, this Justin Bell case in Kentucky, I've talked with a lot of our colleagues about this case, and there's some aspects of this case where people say, oh, this is something different. The fact the DOJ is saying that it could be a crime if the patients don't use the product, that part would be new.
00;20;44;29 - 00;21;05;20
Jonathan Porter
I don't think pharmacies should listen to this and say, well, I've got to go make sure the patients are using whatever drug I'm dispensing or I'm going to go to federal prison. I don't think that's what this case is about. I think this case seems to be about this pharmacist decided he wanted to get people to buy or be prescribed these expensive pads and aggressively got patients to agree to receive them.
00;21;05;20 - 00;21;28;01
Jonathan Porter
And it seems like doctors in some instances were left out of the loop. This case is important because, like you said, when you're dealing with high dollars, you're dealing with high risk. But this case is important because there's a lot of pharmacies that are doing something similar to this. Not long ago, when I was at DOJ, I was prepping some witnesses for a trial, some physician witnesses.
00;21;28;03 - 00;21;49;07
Jonathan Porter
I went to one of the doctor's offices, and she came in with this stack of fax paper of pharmacies that were unsolicited, sending her orders to sign for her patients for things that she did not think were medically necessary. And this is a doc Chase scheme that you hear people talk about. This is going on and it's going on a lot.
00;21;49;10 - 00;22;10;12
Jonathan Porter
And so pharmacies that are doing stuff like this, you just got a tremendous amount of risk. Gone are the days where you say, okay, well a doctor prescribed this and therefore it should be okay. That's really not the way it works anymore. There's just a lot of risk when the pharmacies or a marketer, when they're trying to get a physician to order particular stuff, there's not a blanket prohibition against that.
00;22;10;12 - 00;22;27;12
Jonathan Porter
But you are inviting a lot of risk if you're doing that. It involves a lot of dollars. So, Abe, thanks for talking about the Justin Bell case. I think it's important for our listeners know about it. Thanks for explaining that one to us. So, Abe, close this out by giving us some high level takeaways that pharmacies should be thinking about when it comes to FDA enforcement.
00;22;27;17 - 00;22;41;29
Jonathan Porter
A lot of times on this podcast, we do like this doom and gloom thing where where we're talking about all this enforcement. But I also want to make sure that we're telling our listeners some proactive things that they can do so they can avoid this fate. So, Abe, close this out with some wisdom on that front.
00;22;42;01 - 00;23;12;17
Abe Souza
Yeah, I totally agree, Jonathan. There is definitely a way to navigate this space at a high level. I think our discussion today shows that this is a great time to invest in compliance and have lawyers that your arrangements, if you're a pharmacy, to make sure that you have the right policies in place and that your business doesn't get tripped up by a false Claims Act investigation or enforcement action, I mean, these can be extremely disruptive and distracting at a minimum.
00;23;12;20 - 00;23;36;14
Abe Souza
And even worse, they can end your business. So this is very serious and you need great policies toward that danger off. But you know, one thing I'll say is your policies are only as good as the people following them. I think that's something important to keep in mind. I think there's a tendency sometimes to think that if you can get a policy in place, you've kind of done your due diligence and it takes care of itself from there.
00;23;36;16 - 00;24;07;00
Abe Souza
But if your employee are following the policies, that's bad too. And actually it could be worse because the government can use the existence of your policy to show intent, in other words, that you knew certain conduct violated the law and it happened anyway. So I think the takeaway is that you need to invest great policies and compliance programs, but you have to make sure that your employees are following them as well, and you need to stay on top of that.
00;24;07;03 - 00;24;34;14
Abe Souza
And that's really important because the likelihood is that if something goes wrong, the company, the pharmacy is going to be the one that pays damages and penalties under the False Claims Act or other statutes. And sometimes individuals are held responsible. Sure, but there's a tendency to go after the business itself, and you don't have to look any farther than the CVS and Walgreens cases for that.
00;24;34;16 - 00;24;59;23
Abe Souza
So again, I think compliance is really the name of the game, but also ensuring compliance with the policies that you implement. Lastly, I will say that a lot of this can get pretty technical and this area is changing all the time. And that's why I think having a team with DOJ experience and a team that interacts with these issues on a regular basis is so important.
00;24;59;27 - 00;25;19;13
Abe Souza
Jonathan, obviously you're on top of every single development here in this space, which is fantastic. And that's what we have here at Husch Blackwell. We have a great team with DOJ experience and folks who interact with these issues all the time. Stay on top of them and that's why it's so fun to practice law as a member of this team here at the firm.
00;25;19;16 - 00;25;37;10
Jonathan Porter
Thanks, Abe. I couldn't have said it better myself. That's just fantastic point. I absolutely agree, having a team with DOJ experience when you're dealing with DOJ to me is really important. I know a lot of good lawyers out there who practice in our space who don't have DOJ experience, and they're excellent. I think it's also excellent when you have that DOJ background.
00;25;37;10 - 00;26;00;04
Jonathan Porter
And so, Abe, I couldn't agree more. And the other thing I'll say about our team here, we've got a lot of really smart lawyers who work on the pharmacy compliance front. I understand false Claims Act enforcement. But like you said, Abe, there's a lot of technical details that pharmacists have to know about. I don't know any of those, but I'm lucky that we've got a team that we get to call and say, hey, I've got a client going through X, tell me all about this.
00;26;00;04 - 00;26;23;27
Jonathan Porter
I understand it at the FCA level, but how is it really working? How do pharmacies really address this issue? And learning from their experience is just tremendous. And so that's why it's great to practice at a firm like Husch Blackwell. We were recently named number one by the American Health Law Association because we've got this amazing health law team that backs up our FCA practice, which to me is absolutely fantastic.
00;26;23;27 - 00;26;41;15
Jonathan Porter
It's great to have those subject matter experts on your team in order to help guide these discussions. Because, again, I'm not smart enough to understand the ins and outs of the pharmacy business, but we've got people who do, which is fantastic. And we've got people in other sort of niche areas within the healthcare industry that are excellent as well.
00;26;41;15 - 00;26;50;09
Jonathan Porter
And so, Abe, I appreciate you making that point. I appreciate you coming on the podcast and telling our listeners all about pharmacy enforcement. So, Abe, thanks for joining us.
00;26;50;17 - 00;26;52;20
Abe Souza
Thanks so much, Jon. This is a lot of fun today.
00;26;52;20 - 00;27;12;01
Jonathan Porter
Thanks, Abe. Like I said at the top, this is a tough time to be a pharmacy right now. The pressure on reimbursement rates is real. The pressure, if you're a retail pharmacy without an online service. Foot traffic is down. I think a lot of people during Covid switch to an online model and they're not coming back to foot traffic.
00;27;12;01 - 00;27;30;15
Jonathan Porter
So there's a bunch of people out there who are in a very tough spot and may be looking for additional revenue streams. If you're going to do that, you just got to know what your risks are, and there's a lot of risk when you're dealing with high dollar products. There's a lot of risk when you're identifying the product first and then trying to figure out how do we get doctor to prescribe.
00;27;30;15 - 00;27;51;02
Jonathan Porter
This is not necessarily illegal. And I think a lot of pharmacies get down this road and they think, okay, well, you know, there's no direct prohibition against us identifying the product first and then trying to convince doctors to prescribe it. That's technically true. But boy, there's a lot of ways that you can slip up and get into a real, real trouble, both criminal and FCA.
00;27;51;02 - 00;28;10;27
Jonathan Porter
And so we're going to continue to sort of stay on top of these FCA developments flagged for our listeners. The big things that are happening and try to stay ahead of the curve when it comes to enforcement. And so thanks to our listeners for the excellent feedback. I can't tell you how many great ideas that people reach out to me and say, hey, have you thought about an
00;28;10;27 - 00;28;28;07
Jonathan Porter
episode about X? So if you've got an idea for an episode, feel free to drop me a line. I'd love to hear what it is that people think should be happening. I'm blown away by the feedback that we get. So if you got an idea, by all means reach out to me. I'm not hard to find. But to our listeners, thank you very much for your support, for your interest.
00;28;28;07 - 00;28;37;03
Jonathan Porter
It's an absolute pleasure to do this podcast with you all. And so with that, to our listeners, thank you, and we'll see you next time.