Founder of former BEL20 pharmaceutical company Omega Pharma, he has spread his business interests across several sectors including art, through his company Kamacoucka, and sports, through the co-ownership and sponsorship of the UCI ProTeam Soudal–Quick-Step cycling team, sponsorship of French Ligue 1 side Lille OSC and as major share holder of Belgian Pro League team Anderlecht.

This Belgian pharmaceuticals company grew rapidly and in 2006 employed three thousand people whilst operating in thirty countries.

Whilst his business profile represents considerable achievement there have been highly publicised failures that include the launch of Omega Pharma's E-Waves phone Chip in 2008.

In August 2021 Coucke, together with investment fund Waterland, was convicted to pay €266 million to pharmaceuticals company Perrigo in a dispute over the takeover of Omega Pharma.

Most eye-catching was becoming the major shareholder and chairman of Belgian football club RSC Anderlecht in January 2018 while he already did this before with KV Oostende in 2013.