United States Court of Appeals for the Fifth Circuit ____________ United States Court of Appeals Fifth Circuit

No. 24-10687 FILED June 5, 2025 ____________ Lyle W. Cayce United States of America, Clerk

Plaintiff—Appellee,

versus Quintan Cockerell,

Defendant—Appellant. ______________________________

Appeal from the United States District Court for the Northern District of Texas USDC No. 3:18-CR-623-7 ______________________________ Before Stewart, Clement, and Willett, Circuit Judges. Carl E. Stewart, Circuit Judge: The compounding pharmacy business yields high profits. These pharmacies formulate topical creams by combining ingredients, which can result in extremely high reimbursements from insurers. Quintan Cockerell was reaping the benefits as a marketer for two such pharmacies, but he was eventually convicted for receiving illegal kickbacks as part of a conspiracy to induce physicians to prescribe highly lucrative prescriptions. On appeal, Cockerell challenges the sufficiency of the evidence underlying his convictions, certain purported misstatements of law by the Case: 24-10687 Document: 99-1 Page: 2 Date Filed: 06/05/2025

No. 24-10687

Government during his trial, and the restitution order imposed at his sentencing. For the reasons that follow, we AFFIRM the district court’s judgment. I In 2013, Xpress Compounding (“Xpress”) opened its doors as a compounding pharmacy that accepted federal insurance programs. 1 One of those programs was TRICARE, which covers the United States military. Xpress’s overriding focus was on formulating creams that would be as lucrative as possible. Pharmacists, physicians, and marketers associated with Xpress were all involved in developing combinations of ingredients that “would bill out the highest and be the most profitable.” And it worked. Between July 2014 and September 2016, TRICARE and other federal insurers paid Xpress more than $59 million in total. Cockerell was one of Xpress’s “top marketers” and was considered part of the pharmacy’s “inner circle.” He became extremely effective at recruiting and maintaining relationships with physicians to prescribe pain creams for Xpress to fill. He was also intimately involved in developing new formulas so that Xpress could bill insurers at increasingly high rates. He would, for example, personally seek out prescriptions for creams formulated by other compounding pharmacies to see if Xpress could make their creams as, or more, expensive. To compensate marketers like Cockerell, Xpress paid “commissions.” Marketers received a percentage of a billed prescription’s revenue when the marketer influenced the physician to issue the

_____________________ 1 Xpress had a sister company called Rxpress that handled private insurance claims. Because Rxpress did not accept federal insurance in relevant part, it is not the focus of Cockerell’s convictions or his appeal.

2 Case: 24-10687 Document: 99-1 Page: 3 Date Filed: 06/05/2025

No. 24-10687