Contact

Click here for a confidential contact or call:

1-212-350-2774

Archive

Page 11 of 33

December 19, 2019

Five individuals have been sentenced for their roles in a scheme to defraud TRICARE through the submission of false and fraudulent claims for compounded prescription pain creams.   Marketing firm Centurion Compounding, Inc., owned by  Frank Monte and Kimberley Anderson, entered into an agreement with LifeCare Pharmacy, owned by Carlos Mazariegos and Benjamin Nundy, to pay kickbacks to Dr. Anthony Baldizzi in exchange for him writing prescriptions for compounded creams marketed by Centurion to TRICARE beneficiaries. LifeCare billed health insurers, including TRICARE, more than $12.4 million for compounded cream prescriptions written by Baldizzi and marketed by Centurion, realizing a profit of more than $10 million, which it shared with Baldizzi, Monte, and Anderson.  Centurion also caused TRICARE to be billed additional fraudulent amounts through one or more other pharmacies.  Monte and Anderson of Centurion were sentenced to 2 years and 1.5 years, respectively, and Monte forfeited more than $3 million in property.  Baldizzi was sentenced to 1 year in prison, ordered to forfeit $100,000, and will surrender his license to practice medicine.  Mazariegos and Nundy of LifeCare were sentenced to 1 year in prison and 5 years probation, respectively, and paid over $12.8 million in restitution and forfeiture.  USAO MD FL

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Criminal Proceedings, Other Government Health Programs, Pharma Fraud,

December 3, 2019

In the second settlement to come out of a federal investigation into the generic pharmaceutical industry, Rising Pharmaceuticals Inc. has agreed to pay over $4 million to settle civil and criminal charges stemming from violations of the False Claims Act and Anti-Kickback Statute.  In the criminal case, Rising allegedly teamed up with a competing generic drug manufacturer to fix prices and divide up the market for a hypertension drug, Benazepril HCTZ, while in the civil case, the company allegedly paid and received illegal remuneration through similar arrangements with another generic drug manufacturer.  Under the newly signed deferred prosecution agreement, Rising has agreed to cooperate fully with the ongoing investigation.  DOJ; USAO EDPA

Tagged in: FCA Federal, Healthcare Fraud, Medicaid, Medicare, Pharma Fraud, Price Fixing, Pricing Fraud,

November 20, 2019

The Assistance Fund, a foundation that provided funds for pharmaceutical patient assistance programs, will pay $4 million to resolve claims that it conspired with three manufacturers of multiple sclerosis drugs, Teva, Biogen, and Novartis, to improperly funnel contributions from those companies to patients purchasing drugs from those companies.  USAO MA

Tagged in: Anti-Kickback and Stark, Drug and DME Pricing, FCA Federal, Pharma Fraud,

November 20, 2019

Louisville, Kentucky hospital Jewish Hospital & St. Mary’s Healthcare Inc. has agreed to pay $10.1 million to resolve allegations that the hospital, doing business as Pharmacy Plus and Pharmacy Plus Specialty, submitted false claims to Medicare for prescription drugs that did not have the required physician order or proof of delivery, for prescription refills that were not reasonable and necessary, or for prescriptions that otherwise did not meet Medicare coverage requirements.  In addition, defendant was alleged to have violated the Anti-Kickback Statute by providing unlawful remuneration to patients in the form of free blood glucose testing supplies and waiver of co-payments and deductibles for insulin.  The case was initiated by a qui tam complaint filed by pharmacist Robert Stone, who will receive $1.85 million from the settlement.  DOJ

Tagged in: Anti-Kickback and Stark, FCA Federal, Medical Billing Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

November 15, 2019

Compounding pharmacy Midwest Compounders, Inc., and its owner Troy DeLong, agreed to pay $205,000 to resolve allegations that they submitted false claims to Tricare for prescriptions that resulted from unlawful arrangements between the pharmacy and prescribers or marketers, or otherwise overbilled for medically unnecessary dosages or redundant active ingredients.  The allegations were first made in a qui tam case filed by a whistleblower under the False Claims Act.  USAO ND Iowa

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Other Government Health Programs, Pharma Fraud, Whistleblower Case,

November 15, 2019

Pharmaceutical manufacturer Lupin Limited and related entities, together with company executives Vinita Gupta and Robert Hoffman, will pay $63 million to Texas to resolve claims under the Texas Medicaid Fraud Prevention Action that they reported inflated drug prices to the state's Medicaid program in order to receive excess reimbursements.  The investigation of Lupin was initiated by a whistleblower lawsuit filed by Expess Med Pharmaceuticals, Inc.  TX

Tagged in: Drug and DME Pricing, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case,

November 8, 2019

In the eleventh settlement involving the multi-state OK Compounding Pharmacy fraud scheme, podiatrist Jonathan Moore of Kentucky has agreed to pay $65,404 for the role he played in defrauding federal healthcare programs.  In exchange for illegal kickbacks disguised as “medical director fees,” Dr. Moore allegedly prescribed medically unnecessary compounded pain creams to patients, many of whom were insured by Medicare and TRICARE.  USAO NDOK

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medicare, Other Government Health Programs, Pharma Fraud,

November 7, 2019

Compound drug ingredient supplier Fagron Holding USA LLC has agreed to pay over $22 million to resolve two qui tam suits involving three of Fagron’s wholly-owned subsidiaries.  According to whistleblowers, Freedom Pharmaceuticals Inc. grossly inflated the price of active pharmaceutical ingredients used in compound prescriptions, causing pharmacy customers to submit false claims to TRICARE.  Other allegations involved subsidiaries Pharmacy Services Inc. and B&B Pharmaceuticals Inc., which were accused of submitting false claims to federal healthcare programs, manipulating prescription drug pricing, paying kickbacks to physicians, and illegally waiving patient copays.  DOJ

Tagged in: Compounding Pharmacy Fraud, Drug and DME Pricing, FCA Federal, Other Government Health Programs, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

October 31, 2019

In the largest healthcare fraud case ever to come out of Mississippi, pharmacy owner Thomas Spell has been sentenced to 10 years in prison and ordered to pay over $243 million in restitution for knowingly defrauding TRICARE.  Between 2014 and 2016, Spell and his co-conspirators had deviously marketed compounded medications based on their rate of reimbursement from TRICARE, paid illegal kickbacks to marketers in order to obtain prescriptions from TRICARE beneficiaries, and improperly waived mandatory copayments for TRICARE beneficiaries.  USAO SDMS

Tagged in: Anti-Kickback and Stark, Compounding Pharmacy Fraud, Healthcare Fraud, Other Government Health Programs, Pharma Fraud,

October 29, 2019

A former resident of Atlanta has been sentenced to 1.5 years in prison and ordered to pay $306,179 in restitution for defrauding PERACare, the Colorado Public Employees Retirement Association’s health insurance plan.  For more than two years, Michael Bang allegedly submitted fraudulent reimbursement claims involving three Atlanta-area pharmacies to Express Scripts, which administers PERACare’s prescription benefits. Altogether, his scheme netted him over $300,000.  USAO NDGA

Tagged in: Healthcare Fraud, Medical Billing Fraud, Other Government Health Programs, Pharma Fraud,

1 … 8 9 10 11 12 13 14 … 33

Newsletter

Subscribe to receive email updates from the Constantine Cannon blogs

Sign up for: