Drug Switching Archives - Constantine Cannon

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,

Catch of the Week: Pharmacy Owner Convicted in $174 Million Telehealth Fraud That Targeted Consumers and PBMs

Posted 12/10/21

In yet another example of how unscrupulous providers can take advantage of the benefits of telehealth (or telemedicine) to commit healthcare fraud, on December 2, 2021, a federal jury in Tennessee convicted Peter Bolos, the owner and operator of Synergy Pharmacy, located in Florida, of 22 criminal counts, including violating the Food, Drug and Cosmetic Act (FDCA) by introducing a misbranded drug into interstate...

Tagged in: Catch of the Week, Criminal Proceedings, Drug Switching, Healthcare Fraud, Medicaid, Pharma Fraud, Provider Fraud,

July 2, 2019

For allegedly violating the False Claims Act, mental health nonprofit Wisconsin Community Services, Inc. (WCS) has agreed to pay $537,904 to the United States and the State of Wisconsin. WCS voluntarily disclosed that one of its pharmacists had billed Medicare and Medicaid for brand name medications over several years, even though generic medications had been dispensed. USAO EDWI

Tagged in: Drug Switching, FCA Federal, FCA State, Healthcare Fraud, Medicaid, Medical Billing Fraud, Medicare, Pharma Fraud,

August 8, 2018

Dr. Donald Chamberlain and Karen Chamberlain, the owners of a Chattanooga gynecology practice, will pay $428,000 to settle False Claims Act allegations. According to the government, the Chamberlains used foreign-sourced, non-FDA approved, anticancer drugs, and billed Medicare and Tennessee’s Medicaid programs for similar, approved drugs. The drugs the Chamberlains used were cheaper than similar drugs that were approved by the FDA. USAO Eastern District of Tennessee

Tagged in: Drug Switching, FCA Federal, Healthcare Fraud, Provider Fraud,

June 7, 2017

New York announced that Kester Atumonyogo, of Valley Stream, NY, and his company Monack Medical Supply, Inc. were arraigned on an indictment charging Atumonyogo and Monack with billing Medicaid and Healthfirst, a Medicaid managed care organization, for an expensive nutritional formula while supplying patients with a lower-priced substitute and stealing over $1 million in the process. Atumonyogo, 49, was arraigned in New York Supreme Court, Kings County, by the Honorable Danny K. Chun. According to the indictment, Atumonyogo used a fraudulent social security number to enroll Monack as a Medicaid-participating provider of medical supplies. The company then allegedly filed false claims to Medicaid and Healthfirst that Monack had dispensed to pediatric patients a highly specialized and expensive enteral nutritional formula, which is prescribed by physicians for patients who must obtain nutrients via a feeding tube and cannot metabolize dietary nutrients from substantive food. NY

Tagged in: Drug Switching, Healthcare Fraud, Managed Care, Medicaid,

May 16, 2017

Omnicare Inc. agreed to pay $8 million to settle charges it violated the False Claims Act by submitting claims for generic drugs different from those actually dispensed to Medicare and Medicaid beneficiaries. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by Elizabeth Corsi and Christopher Ezzie. They will receive a whistleblower award of more than $2 million from the proceeds of the government's recovery. DOJ (DNJ)

Tagged in: Drug Switching, Medicare, SNF, Whistleblower Case, Whistleblower Rewards,

February 16, 2017

New Jersey doctor Kenneth D. Nahmu, his wife Ann Walsh and their oncology practice agreed to pay $1.7 million to resolve allegations they violated the False Claims Act by billing Medicare for illegally importing and using unapproved chemotherapy drugs from foreign distributors. DOJ (DNJ)

Tagged in: Drug Switching, FCA Federal, Medicare,

September 20, 2016

New York announced the sentencing of licensed pharmacist Glenn Schabel, 55, of Melville, and his company, Glenn Schabel, Inc. in connection with a nation-wide scheme to sell diverted HIV medication to unsuspecting New Yorkers. Schabel was sentenced to 2-6 years in prison, and forfeited $5,456,267 to the New York State Medicaid Program. This sentencing is part of the Attorney General’s Medicaid Fraud Control Unit’s (“MFCU”) “Operation Black-Market Meds” investigation. NY

Tagged in: Drug Switching, Medicaid,

May 9, 2016

CA oncologist Dr. John F. Kiraly and his wife Rena Kiraly, who served as the doctor’s office administrator, have paid $300,000 to settle allegations that they violated the False Claims Act by improperly billing Medicare for certain chemotherapy drugs purchased from an unlicensed foreign pharmaceutical distributor. Specifically, the Kiralys purchased chemotherapy drugs from Warwick Healthcare Solutions Inc., also known as Richards Pharma, a former United Kingdom-based drug distributer that distributed non-FDA approved drugs throughout the United States. DOJ (EDCA)

Tagged in: Drug Switching, FCA Federal,

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)

Tagged in: Dosage Fraud, Drug Switching, Healthcare Fraud, Medical Billing Fraud, Medicare, Pharma Fraud, Provider Fraud, Upcoding, Whistleblower Case, Whistleblower Rewards,

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