Archive

November 15, 2016

Florida pharmacies Lemon Bay Drugs North, Inc. and Brooksville Drugs, Inc. agreed to pay a total of $750,000 to resolve allegations that the pharmacies violated the False Claims Act by causing claims to be submitted to federal health care programs for prescription drugs that were never dispensed.  According to the government, the pharmacies provided Medicare and Medicaid patients generic versions of certain medications, but charged Medicare and Medicaid for the brand name versions of those medications.  The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former pharmacy technician who worked at Lemon Bay Drugs.  She will receive a whistleblower award of $142,500 from the proceeds of the government's recovery.  DOJ (MDFL)

December 20, 2016

Massachusetts announced that a Burlington woman has been sentenced to jail and ordered to pay up to $570,000 in restitution for stealing from public agencies by billing for unlicensed psychological services. Nita Guzman, age 52, pleaded guilty on Friday in Middlesex Superior Court to the charges of Medicaid False Claims (2 counts), False Claims to Public Agency (1 Count), Larceny (4 Counts), and Unlicensed Practice of Psychology (2 Counts). An AG’s investigation revealed that Guzman, through her company New England Psychological Consultants, Inc., billed Medicaid, Medicare, and Lawrence Public Schools more than $550,000 for unlicensed mental health services. MA

December 15, 2016

Ohio joined 19 other state attorneys general in filing a federal lawsuit against Heritage Pharmaceuticals and several other generic drug makers accused of conspiring to reduce competition and inflate prices in the United States for two drugs: doxycycline hyclate delayed-release (an antibiotic) and glyburide (a diabetes medication). The lawsuit names as defendants Heritage Pharmaceuticals Inc., Aurobindo Pharma USA Inc., Citron Pharma LLC, Mayne Pharma (USA) Inc., Mylan Pharmaceuticals Inc., and Teva Pharmaceuticals USA Inc. The states allege that Heritage Pharmaceuticals, through senior executives and salespeople, organized and initiated a wide-ranging series of conspiracies with other companies to allocate markets, artificially inflate and manipulate prices, and otherwise thwart competition. According to the complaint, the defendants routinely coordinated their schemes by interacting directly with competitors at events, such as industry trade shows and customer conferences, and through direct email, phone, and text message communications. OH

December 14, 2016

Florida announced a million dollar settlement reached with an obstetrician and gynecologist in Ocala. Dr. Rasiklal Dhanji Nagda is a Medicaid provider and owner of Nagda Medical, Inc. According to Attorney General Bondi’s Medicaid Fraud Control Unit’s investigation, Nagda submitted more than 700 claims to Medicaid for intrauterine devices not approved by the Food and Drug Administration, and received reimbursements from the Medicaid program. Nagda allegedly used a credit card to order large quantities of Bayer’s Mirena IUDs from an online pharmacy, GetCanadianDrugs.com, on a monthly basis. FL

December 8, 2016

New York and 41 other states announced a $19.5 million multistate agreement with Bristol-Myers Squibb (“BMS”) arising from alleged improper marketing and promotion of the drug Abilify. Abilify is one of several second-generation antipsychotic prescription drugs, commonly referred to as “atypical antipsychotics,” that were originally used to treat schizophrenia. New York alleged that BMS improperly promoted Abilify for pediatric use and for use in elderly patients with symptoms consistent with dementia and Alzheimer’s disease. In fact, in 2006, Abilify received a “black box” warning stating that elderly patients with dementia-related psychosis who are treated with antipsychotic drugs have an increased risk of death. The complaint further alleged that BMS violated state consumer protection laws by misrepresenting and minimizing risks of the drug including metabolic and weight gain side effects and by misrepresenting the findings of scientific studies. NY, GA

November 21, 2016

Georgia 41 other states filed an amended antitrust lawsuit against the makers of Suboxone, a prescription drug used to treat opioid addiction, over allegations that the companies engaged in a scheme to block generic competitors and cause purchasers to pay artificially high prices. Reckitt Benckiser Pharmaceuticals, now known as Indivior, is accused of conspiring with MonoSol Rx to switch Suboxone from a tablet version to a film (that dissolves in the mouth) in order to prevent or delay generic alternatives and maintain monopoly profits. According to the lawsuit, when Reckitt introduced Suboxone in 2002 (in tablet form), it had exclusivity protection that lasted for seven years, meaning no generic version could enter the market during that time. Before that period ended, however, Reckitt worked with MonoSol Rx to create a new version of Suboxone – a dissolvable film, similar in size to a breath strip. Over time, Reckitt allegedly converted the market away from the tablet to the film through marketing, price adjustments, and other methods. GA

November 16, 2016

New York announced that Zwanger & Pesiri Radiology Group, LLP, Zwanger Radiology P.C. and Dr. Steven Mendelson (collectively, “Zwanger”) will pay $8,153,727 to resolve allegations that the defendants knowingly submitted false claims to Medicare and Medicaid. The settlement resolved allegations that from January 1, 2003 through October 26, 2015, Zwanger submitted claims for services provided or supervised by physicians, or at a Zwanger location, that were not enrolled in Medicare and/or Medicaid and therefore ineligible for payment. Zwanger falsely claimed that Dr. Mendelson, who was a Medicare and Medicaid enrolled provider, had in fact performed the procedures. The settlement also resolved allegations that from January 1, 2008 through February 28, 2014, Zwanger submitted false claims to Medicare and Medicaid for certain radiology procedures that were not ordered by a treating physician. These procedures included the automatic performance of certain types of x-rays, and the automatic performance of ultrasounds in female patients, even these both procedures were not ordered by a treating physician. NY

November 16, 2016

Washington announced that CHI Franciscan will provide more than $1.1 million in healthcare cost relief after an investigation into mislabeled charges and inadequate fee disclosures. CHI Franciscan operates three urgent care clinics in Kitsap County that charge a facility fee due to their affiliation with the hospital. The clinics must disclose the fee to patients through a variety of methods, including identification on the clinic’s website, signage at the clinic and a notice provided to patients before they receive care. The Attorney General pursued an investigation based on evidence that Franciscan did not meet its obligation to disclose this fee. In addition, the Attorney General investigated concerns that CHI Franciscan mislabeled facility fees as emergency room fees during a three month period in 2015. WA

November 11, 2016

Marie Neba, co-owner of Houston-based home-health agency Fiango Home Healthcare Inc., was convicted for her role in a $13 million Medicare fraud and money laundering scheme.  According to the evidence presented at trial and admissions made in the guilty plea of her husband and co-owner Ebong Tilong, Neba and Tilong paid illegal kickbacks to physicians in exchange for authorizing medically unnecessary home-health services for Medicare beneficiaries.  They also paid illegal kickbacks to patient recruiters for referring Medicare beneficiaries for home-health services and to Medicare beneficiaries for allowing them to bill Medicare using their Medicare information for home-health services that were not medically necessary or not provided.  Neba and Tilong also falsified medical records to make it appear as though the Medicare beneficiaries qualified for and received home-health services.  DOJ

November 8, 2016

Niurka Fernandez and her son Roberto Alvarez were sentenced to 120 months and 30 months in prison, respectively, for their roles in spearheading a $9.5 million health care fraud conspiracy that targeted Medicare Part D.  In addition, Fernandez and Alvarez were ordered to pay respectively $9.5 million and $1.5 million in restitution and to forfeit the same amounts.  As part of her guilty plea, Fernandez admitted she co-owned and operated several pharmacies in the Miami area, including Calan Pharmacy & Discount Service LLC and Bertyann Corp. (doing business as Best Pharmacy), for the purpose of submitting false and fraudulent claims through Medicare Part D by paying kickbacks to Medicare beneficiaries and patient recruiters for prescriptions that were medically unnecessary.  DOJ