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July 26, 2022

Mallinckrodt ARD, LLC f/k/a Questcor Pharmaceuticals, Inc. will pay over $233 million over a 7-year period to settle False Claims Act violations, which occurred from January 2013 through June 2020. During this time, Mallinckrodt knowingly underpaid Medicaid rebates on its H.P. Acthar Gel. The practice was exposed by a whistleblower lawsuit originally filed in Massachusetts. Mallinckrodt paid rebates for Achtar in 2013 as if it was a “new drug” rather than one that was introduced to the market in 1952. NJ OAG

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Medicaid, Pharma Fraud, Whistleblower Case,

July 26, 2022

Teva will pay $4.25 billion to resolve allegations that it promoted potent fentanyl products to non-cancer patients, deceptively marketed opioids by downplaying the addiction risks and overstating the drugs’ benefits, and failed to comply with suspicious order monitoring requirements. The final settlement is contingent on agreement on critical business practice changes and transparency requirements. CA AG, PA OAG

Tagged in: Healthcare Fraud, Pharma Fraud,

July 13, 2022

Solera Specialty Pharmacy and its CEO, Nicholas Saraniti, has agreed to pay $1.31 million and enter into a three-year integrity agreement to resolve allegations of defrauding Medicare.  Solera allegedly submitted fraudulent claims for Evzio—a high-priced version of naloxone, which reverses opioid overdoses—based on prior authorization requests that contained false clinical information, that were not actually approved by physicians, and that improperly listed Solera’s contact information as if it were the physician’s.  In connection with a criminal information, Solera has also entered into a deferred prosecution agreement.  The whistleblower in this case, a former employee of Evzio manufacturer kaléo Inc. named Rebecca Socol, will receive a $262,000 share of the settlement.  DOJ

Tagged in: FCA Federal, Healthcare Fraud, Medicare, Pharma Fraud, Whistleblower Case, Whistleblower Rewards,

June 13, 2022

Centene Corporation has agreed to pay $13.7 million to the State of New Mexico, after an investigation by the Attorney General’s Office found the company layered fees and failed to pass discounts onto the state’s Medicaid program, in violation of Medicaid rules and the New Mexico Medicaid False Claims Act.  NM AG

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

June 8, 2022

Pharmaceutical manufacturer Dr. Reddy’s Laboratories (DRL) has agreed to pay $12.9 million to the State of Texas to resolve allegations of violating the Texas Medicaid Fraud Prevention Act.  DRL had allegedly reported inflated drug prices to the Texas Medicaid program in order to receive higher reimbursements.  TX AG

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

May 24, 2022

Dr. Roger Wang will pay over $1 million for violations of the False Claims Act committed by charging Medicare for non-FDA-approved drugs and associated services. Dr. Wang, a rheumatology specialist, injected his patients with drugs like Synvisc, Synvisc One, or Orthovisc—vicosupplements used to treat osteoarthritis pain—that were not FDA-approved for distribution in the US, and therefore not billable to Medicare. USAO NDCA

Tagged in: Drug Switching, FCA Federal, Healthcare Fraud, Medicare, Off-Label and Unapproved Use, Provider Fraud,

May 18, 2022

Peter Bolos and Michael Palso, owners of Synergy Pharmacy, were sentenced to 14 years and 33 months in prison, respectively, and each will pay $24.6 million in restitution for defrauding pharmacy benefit managers into authorizing millions of dollars in claims paid to pharmacies controlled by the defendants. Bolos will forfeit an additional $2.5 million. The conspiracy involved cold-calling patients and deceiving them into accepting certain drugs (i.e., pain creams, scar creams, and vitamins) and providing their personal insurance information to receive them. The scheme impacted both private and public insurers, including Medicaid and TRICARE. DOJ, USAO EDTN

Tagged in: Compounding Pharmacy Fraud, Criminal Proceedings, FCA Federal, Healthcare Fraud, Medicaid, Other Government Health Programs,

May 3, 2022

McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Drug Corp. will pay $518 million for their role in fueling the opioid epidemic. The three companies made billions by shipping excessive amounts of oxycodone, fentanyl, hydrocodone, and other prescription opioids, knowing they would likely wind up in the hands of drug dealers and people suffering from substance use disorder, and often filled orders without adequate identification or reporting. WA AG

Tagged in: Healthcare Fraud, Pharma Fraud,

April 27, 2022

Dr. Josef Schenker and his urgent care facilities, Josef Schenker, M.D., P.C., and Care Partners Medical Management, LLC will pay $564,217.70 for violations of the False Claims Act, by submitting up-coded claims to Medicare related to administration of the COVID-19 vaccine. Schenker and the two facilities provided higher-level CPT codes for services not actually provided, charging, e.g., for an office visit or exam when the patient only actually received a vaccine or a COVID test. EDNY

Tagged in: FCA Federal, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud, Provider Fraud, Upcoding,

April 26, 2022

A former pharmacist in Mississippi named Mitchell Barrett has been sentenced to 10 years in prison and ordered to pay restitution as well as forfeit all assets stemming from a $180 million healthcare fraud scheme against TRICARE and other health benefit programs.  Barrett had adjusted prescription formulas to ensure the highest possible reimbursement, solicited recruiters to procure prescriptions for expensive compounded drugs, paid those recruiters a commission based on reimbursements from TRICARE, routinely waived copayments required to be paid by TRICARE beneficiaries, and took steps to disguise the waived payments.  DOJ

Tagged in: Compounding Pharmacy Fraud, FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Other Government Health Programs, Pharma Fraud,

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