Archive

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $209.2 million to settle a False Claims Act case brought by two whistleblowers alleging that the retail pharmacy chain knowingly dispensed insulin pens to patients who did not need them, and billed Medicare, Medicaid, and other government insurance programs for those unnecessary items. As part of the settlement, Walgreens admitted that it prevented pharmacists from dispensing fewer than five insulin pens at a time and altered records regarding dispensing information and days-of-supply so that patients received more insulin pens than they actually needed. $168 million of the settlement will be paid to the U.S., and approximately $41.2 million to state governments. The whistleblowers, Adam Rahimi and S. Christopher Schulte, will receive a share of the total settlement, to be determined at a later date. USAO SDNY. See also, NY, OH

Tagged in: Dosage Fraud, FCA Federal, FCA State, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

January 11, 2019

Teva Pharmaceuticals USA Inc. will pay $135 million to the state of Illinois to settle allegations that published fraudulently inflated Average Wholesale Prices (AWPs) for numerous prescription drugs. Illinois's Medicaid program bases its drug reimbursements for Medicaid beneficiaries on AWPs, and the inflated AWPs caused Illinois to overpay. IL AG

Tagged in: Drug and DME Pricing, Medicaid, Pharma Fraud,

December 14, 2018

Tamar Tatarian, owner of Akhtmar Pharmacy, was found guilty for her part in a scheme to defraud Medicare out of more than $1.3 million in false claims for prescription drugs. According to evidence presented during the two-day trial, Tatarian submitted false claims to Medicare Part D plan sponsors between October 2015 and October 2017 for prescription drugs that Akhtmar pharmacy had not actually ordered from wholesalers, and therefore were not dispensed to Medicare beneficiaries. Tartarian tried to cover up the fraud by generating fake invoices that included wholesale drug purchases by the pharmacy which had not, in reality, ever happened. Tatarian was convicted of one count of health care fraud and two counts of wire fraud. DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud,

December 11, 2018

Target Corp. will pay $3 million to settle allegations that it improperly billed and received payments from the state’s Medicaid program (MassHealth). Between August 2009 and July 2015, at their Massachusetts locations, Target allowed auto-refills on prescriptions that were not clearly requested by a MassHealth patient or caregiver at the time of refill. The investigation arose from a qui tam action by an unnamed whistleblower in the United States District Court for the District of Minnesota. Mass AG

Tagged in: FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

December 6, 2018

Actelion Pharmaceuticals US, Inc., will pay $360 million to settle claims that it violated the False Claims Act by means of illegally using a foundation as a channel through which it paid the copays of thousands of Medicare patients who were taking Actelion’s pulmonary arterial hypertension drugs to induce patients to purchase the medications. Actelion collected data from the foundation on its spending for patients and used this information to calculate its donations to the foundation, ensuring that its contributions were adequate to cover the copays of patients taking the subject drugs. The company continued these practices despite allegedly receiving warnings from the foundation. DOJ

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

November 16, 2018

A New Jersey-based doctor, Dr. Bernard Ogon, has been charged with participating in a compound pharmacy fraud that caused over $20 million in losses to health care benefit programs, including $3 million in losses to TRICARE. In exchange for a per-prescription payment, Ogon allegedly signed prescriptions that were pre-filled by telemedicine companies on behalf of patients he never saw. On multiple occasions, the prescriptions were for pain and scar creams that were not medically necessary, and were in fact exorbitantly expensive when made by a compound pharmacy. Ogon was also accused of writing prescriptions for patients in states that he was not licensed to practice in; if convicted, he faces a maximum of 10 years in prison. USAO NJ

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs,

October 26, 2018

Abbott Laboratories and AbbVie, Inc. have agreed to pay $25 million to settle a case initiated by a whistleblower alleging that the pharma companies paid unlawful kickbacks and engaged in unlawful off-label marketing for the drug TriCor. The kickbacks took the form of gifts and payments for consulting and speaking engagements that were meant to induce or reward physicians for prescribing TriCor. The off-label marketing consisted of Abbott's advertising the drug for conditions for which it was not FDA-approved. The whistleblower, Amy Bergman, a former Abbott sales representative, will receive $6.5 million of the settlement. USAO E.D.Pa.

Tagged in: Anti-Kickback and Stark, FCA Federal, Off-Label and Unapproved Use, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

October 22, 2018

A Kentucky-based medical equipment supplier has agreed to pay $5,254,912 to settle claims based on the False Claims Act that it defrauded many government insurers, including Kentucky Medicaid, Medicare, and CHAMPVA (under the Department of Veterans Affairs), by submitting fraudulent claims relating to certain compounded creams that it produced. According to the DOJ press release, in order to be properly reimbursed, Cooley Medical Equipment, Inc. was required to obtain prior authorization from Kentucky Medicaid and CHAMPVA before using certain powdered ingredients. Instead, Cooley claimed to use cream-based versions of the same ingredients, then submitted thousands of false claims to the insurers, and received millions of dollars in reimbursements. The company eventually came clean and self-disclosed to the US Attorney's Office, allowing it to pay a fine of 1.5 times instead of the usual 3 times loss suffered by the government. USAO EDKY

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Medicaid, Medicare, Other Government Health Programs, Pharma Fraud,

October 18, 2018

Four individuals have pleaded guilty to conspiring to violate the Anti-Kickback Statute for a scheme that made payments to patient recruiters and a medical office assistant to find TRICARE beneficiaries to get prescriptions for compounded prescription pain cream, scar cream, and supplements from a doctor who had never seen the patients. In less than one year, the scheme generated over $10 million in compound prescriptions for over 100 TRICARE beneficiaries. E.D. Ark.

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

October 9, 2018

A Florida-based pharmacy owner has plead guilty to defrauding Medicare of $8.4 million. In order to generate income for his pharmacy, Valles Pharmacy Discount, Antonio Perez Jr. allegedly paid kickbacks to Medicare beneficiaries and submitted claims on their behalf for medically unnecessary prescriptions that were not purchased by the pharmacy or provided to the beneficiaries. DOJ

Tagged in: Healthcare Fraud, Lack of Medical Necessity, Pharma Fraud,

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