INDIANAPOLIS — A woman has pleaded guilty in Indiana federal court after spearheading a multi-year healthcare fraud conspiracy against Eli Lilly with seven individuals.
According to court documents filed earlier this month in the United States District Court for the Southern District of Indiana, Courtney Anguiano pleaded guilty to one count of conspiracy to commit healthcare fraud. Anguiano faces a maximum sentence of 10 years in prison, a $250,000 fine and three years of supervised release.
The complaint, filed on Oct. 10 in federal court, said that Lilly created a prescription co-pay savings card program with a pharmaceutical marketing company for three of its medications: Verzenio, a medication for breast cancer treatment; Olumiant, a medication for rheumatoid arthritis treatment; and Trulicity, a medication for type 2 diabetes treatment.
While the lawsuit does not name Eli Lilly directly, the complaint referred to the company as a pharmaceutical company with headquarters in Indianapolis. Eli Lilly is the developer of all three of the medicines specified in the lawsuit as well.
Aimed at lowering the out-of-pocket costs for the three medications, patients could obtain a savings card and present it at the time of purchase at participating retail stores to instantly receive a discount on the respective medication. According to the documents, patients could also pay full price for the medicine and seek reimbursement by submitting a post-transaction reimbursement, or PTR, request.
To submit a PTR request, patients are required to provide certain information, including identifying information about the patient, proof of purchase of the medication, as well as savings card information. The pharmaceutical marketing company, which runs the savings card program, then reviews the request and mails checks to patients on behalf of Eli Lilly if the PTR request is approved.
Officials said in the documents that between Sept. 1, 2017, and July 26, 2020, Anguiano conspired with seven individuals to acquire multiple savings cards for the medications when they did not have valid and current prescriptions for the medications. The documents said that the group submitted around 189 “materially false and fraudulent PTR requests” and provided counterfeit documents to support the claims. Out of these claims, the group received $648,528.22 in reimbursement checks, drawn from Eli Lilly’s account.
The plea agreement said that Anguiano agreed to pay $648,528.22 in restitution to Eli Lilly, the amount that was fraudulently obtained by the reimbursement checks. The plaintiff also agreed to recommend that the judge in the case Anguiano “at the low end of the guideline range determined by the court” if Anguiano:
- continues to fully accept responsibility for the offense;
- does not commit a new criminal offense before the date of any sentencing;
- does not otherwise violate the terms of any pre-trial release before the sentencing date.
An initial virtual hearing in this case has been scheduled for 1:30 p.m. on Dec. 4, according to court documents. A sentencing date has not yet been scheduled.