Dosage Fraud

March 2, 2021

Medical practice Allergy and Asthma Associates Inc., in Roanoke, Virginia, will pay $2.1 million to resolve allegations that it fraudulently billed Medicare and Medicaid for asthma treatments.  AAA treated patients with Xolair, an asthma treatment sold in single-use vials, and billed government healthcare programs for the entire vial when, in fact, they were splitting vials between different patients.  USAO WDVA

June 30, 2020

Ophthalmic Consultants, P.A. and its principal Robert K. Snyder have agreed to pay $4.8 million to resolve claims that they unlawfully billed federal healthcare programs for the drugs ranibizumab (Lucentis®) and aflipercept (Eylea®).  While the drugs are sold in single-use vials, defendants used single vials to provide doses to multiple patients, allowing them to obtain excessive reimbursement from Medicare, TRICARE, and the Federal Employees Health Benefits Program.  USAO MD FL

September 5, 2019

El Paso Integrated Physicians Group, P.A., several physicians in the group, and Accutrack Medical Claims Services, LLC, have agreed to pay $2.93 million to resolve a False Claims Act case filed by whistleblower Sergio Garcia alleging that they double-billed and over-billed government payors for the infusion drug Remicade (Infiximab).  Remicade is sold in single-use vials; defendants were alleged to have pooled Remicade from partially-used vials, diluted Remicade, and illegally imported drugs from Canada and other foreign countries.  USAO WD Tex

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

October 1, 2018

Pharmaceutical distributor AmerisourceBergen Corporation will pay $625 million to the federal government and 43 states to settle claims that between 2001 and 2014 a pre-filled syringe program at one of its subsidiaries, Medical Initiatives, Inc., violated federal law.  Despite lacking the proper licensing and registration, MII opened FDA-approved sterile vials of oncology drugs, and in a non-sterile environment, pooled the medicine and transfered it into non-FDA approved pre-filled syringes which were then sold to oncology practices and physicians.  This practice allowed Amerisource to capture the "overfill" in the original FDA-approved sterile vials and produce a larger number of pre-filled syringes.  AmerisourceBergen also resolved claims that it provided unlawful kickbacks to physicians to induce them to purchase pre-filled syringes rather than vials.  The settlement resolved three qui tam actions initiated by whistleblowers Michael Mullen, Daniel Sypula, Kelly Hodge, and Omni Healthcare, Inc.; a payment of over $93 million will be made to relators. Previously, in September, 2017, AmerisourceBergen Specialty Group pleaded guilty to illegally distributing misbranded drugs and agreed to pay $260 million in criminal fines and forfeitures. USAO E.D.N.Y.;  NY

February 19, 2016

Adventist Health System Sunbelt Healthcare Corporation agreed to pay $2.09 million to resolve allegations that patients were administered portions of single-dose vials of chemotherapy drugs that were left over from administrations to prior patients.  The settlement also resolves allegations that some platinum based drugs were administered inappropriately and that certain infusion services were upcoded.  The allegations originated in a whistleblower lawsuit filed by former Adventist employee Heather Huddleston under the qui tam provisions of the False Claims Act.  She will receive a whistleblower award of $376,452 from the proceeds of the government's recovery.  DOJ (MDFL)