Robert Courtney Case Puts Face on Health Care Fraud

Vol. 16 •Issue 20 • Page 18
Robert Courtney Case Puts Face on Health Care Fraud

It probably seemed like a good idea when he started,” observed a pharmacist in Kansas City, Mo., giving his opinion about the drug dilution scandal that sent another pharmacist, Robert Courtney, to jail for 30 years and left Courtney’s wife, children, and father facing legal fights from injured victims and the federal government.

The sad tale of Courtney and his scheme stands as but one stark example of what happens if you defraud Medicare and hurt patients.

“Robert Courtney stole the trust and hope of his victims,” said U.S. Attorney Todd Graves. As a cancer survivor, Graves knows the importance of such hope and trust. He indicated he was satisfied with the 30-year sentence, which was the maximum the court could give Courtney under the terms of a plea agreement between Courtney’s lawyers and the federal government.

“It all started with Courtney shorting people on the pills that they bought,” said Attorney Jim Bartimus, of the law firm of Bartimus, Frickleton, Robertson & Obetz, Jefferson City, Mo.

According to sealed deposition testimony taken in the case, Courtney began as a new pharmacist by giving people 25 pills when the prescription called for 30. If the mistake was discovered, Courtney made good on the missing pills. But over time, he discovered very few of his customers actually caught the error.


At some point, Courtney looked to make more money. He didn’t have to look far. Chemotherapy medications are notoriously expensive, and some doses of the medication cost in excess of $2,000 a vial. Courtney apparently reasoned that if people didn’t discover missing pills when there were supposed to be a set number in the bottle, surely they would never catch on to the fact that he was giving them less chemotherapy in a pre-mixed IV bag than they expected.

When he was finally caught, Courtney was giving some patients sterile saline. Others were getting only 1 percent to 2 percent of the chemotherapy drugs they were buying. Courtney was pocketing in excess of $3,000 per patient per treatment by some estimates. And the scheme went on for quite some time.

Courtney apparently reasoned he didn’t have to worry about anyone looking into his behavior because the patients all had cancer. If they died, their death would be blamed on the cancer, not on drug dilution.

“We were able to find evidence of dilution going back at least as far as 1998,” said Bartimus, whose firm helped prosecute the civil lawsuits against Courtney. “But some of our patients received drugs as long as 10 years ago, and they still have to wonder if they received the appropriate dose.”

How did the FBI catch Courtney? The case began to unravel because a drug representative didn’t think he was getting his full commission for drug sales and started asking questions that couldn’t be easily answered.


Darryl Ashley, a representative for a major drug company, was concerned because he knew doctors at Research Hospital were using his company’s cancer drug. When he asked them how much they were using, they showed him numbers that didn’t match up with the numbers he had on his sales reports.

One of the physicians he talked to was Verda Hunter, a respected gynecologic oncologist. After she showed him how much of the medication she was using, Ashley remarked that he wasn’t getting any credit for those sales, so something must be wrong.

That triggered, by all accounts, the adding of one plus one in the minds of the clinicians. All of them agreed that patients who received chemotherapy in the hospital tended to lose hair and have more side effects than those who got the medications in a physician’s office. Hunter wondered whether her patients were getting the appropriate drugs.

Hunter eventually wrote to Ashley’s drug company to get assistance in testing drugs received from Courtney’s pharmacy. The drug company could not assist her, but she did find a separate laboratory that could test chemotherapy agents.

“Dr. Hunter sent the chemotherapy obtained for our client, Demory Buycks, to the lab for testing, and it came back at something like 2 percent strength,” Bartimus says. “At that point, Dr. Hunter’s next call was to the FBI.”

The FBI had the U.S. Food and Drug Administration test other chemotherapy samples obtained from Courtney’s pharmacy and found that nearly all of them were not only sub-therapeutic doses, but were in fact, sometimes nothing more than saline. FBI agents arrested Courtney, and the Kansas City area woke up on August 15, 2001, to the horror of knowing that hundreds of patients had not really received treatment for their cancer.


“You can’t imagine what that’s like,” said cancer victim Connie Remby. “It’s bad enough you have a terrible disease, and you know that every day you have to battle it. But then, finding out that you’ve been given water instead of drugs. I couldn’t even breathe when I found out.”

Remby, who died last fall from the ravages of breast cancer, was one of a handful of health care providers like Veronica Jenkins who received chemotherapy from a trusted member of the health care team.

“You never expect that the guy you’ve worked with, said hello to and exchanged gossip with over two years might secretly be killing you,” Jenkins said. “But here was Robert Courtney, a guy I said hello to and talked with on at least a dozen occasions, and he was all the while killing me as surely as if he’d used a gun.”

Jenkins was a radiologic technologist at Research Hospital and went to Research-based doctors for her chemotherapy. When she discovered Courtney had been arrested, her initial reaction was one of disbelief. That reaction turned to horror when she began to compare notes with Remby.

“Neither one of us lost our hair,” Jenkins said. “And neither one of us got sick on the Taxol. I realized in one sickening moment that I’d been cheated out of a chance for life.”

Jenkins lost her battle with cervical cancer last summer, only days before Courtney was sentenced to 30 years for his crimes. “It’s not enough,” said widower Robert Jenkins. “There is not a punishment that fits this crime.


“That view is echoed by a lot of our clients,” said Bartimus. He and a team of other attorneys were successful in obtaining a large settlement from the drug companies, although he won’t discuss the amount. “The battle now is trying to get the pharmacy’s insurance company to pay the claims made against it. We have a team of lawyers working on that now,” Bartimus added.

The criminal case put together by the FBI and U.S. Attorney’s office focused on the dilution and mislabeling of the prescriptions. “The U.S. Attorney has no jurisdiction to prosecute Courtney for murder or crimes against the victims themselves,” said Bartimus. “That is the state’s job, and the evidence simply wasn’t there to get a conviction. But the U.S. Attorney did a great job in going after Courtney for health care fraud.

Courtney got off easy. Although he was ordered to pay more than $10 million in restitution, the effect of that order remains unknown. If Courtney had been tried for the Medicare Fraud he perpetrated under the Federal False Claims Act, he could have faced liability in the billions of dollars.

As things stand, the federal court is still trying to determine who Courtney’s victims were and how badly they were damaged. It may be years before any of the victims or their families see a dime of the restitution.

“We know there were over 10,000 separate prescriptions filled for chemotherapy agents over the course of the last two years,” said Bartimus. “If you multiply the number of prescriptions by the civil penalty available to the government ($11,000), you can quickly see that Courtney escaped more serious liability by agreeing to plead guilty to criminal charges.”


Other health care providers have faced similar charges. Dr. Forrest H. Braack, a clinical psychologist, was arrested and charged with two counts of health care fraud for billing Medicare for services provided to a patient who was out of state at the time that the services were billed. Braack was ordered to pay $102,000 in restitution and more than $20,000 in civil penalties in this case.

In yet another drug dilution case, a paramedic with an ambulance service in Pleasant Valley, Mo., was charged in a 10-count indictment by a federal grand jury with removing carpujects of Demerol and replacing the Demerol with sterile saline.

If convicted, the paramedic could receive in excess of 10 years in a federal prison. “Federal and state prosecutors have become more vigilant in these cases,” said Bartimus, who thinks this is a good thing. “Civil actions for health care fraud are one way to reduce the harm to patients, but the best way is to put those guilty of criminal acts behind bars,” he said.

While health care fraud has diminished nationally, according to recent estimates, local prosecutors are still vigilant for instances like the Courtney case that put a more human face on a crime that is generally thought of as white collar.

“In most white collar crimes, you expect to have an insurance company or a big corporation as the victim,” Bartimus said. It is hard for a jury to feel too sorry for a big company when that company loses a little money. But health care fraud cases like Courtney teach a different and painful lesson. If you engage in the fraud at some point, what you do is hurt patients. And if you do that, you make yourself a target of prosecution.”

A.L. DeWitt is a Missouri attorney.