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Part D

This archive displays posts tagged as relevant to the Medicare Part D program and fraud in Medicare Part D. You may also be interested in our pages:

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September 24, 2018

The owner and operator of several Superdrugs pharmacies in Queens, New York, was charged with submitting false claims to Medicare Part D and Medicaid for prescription drugs that were not dispensed, were not prescribed as claimed, or not medically necessary.  The pharmacies allegedly received $7.9 million from Medicare and Medicaid based on the fraudulent claims.  DOJ

Third Circuit Clarifies the Public Disclosure Bar in United States ex rel. Silver v. PharMerica

Posted  09/7/18
Whistleblower Marc Silver secured a victory from the Third Circuit on September 4, 2018, which held that his action was not blocked by the “public disclosure bar” of the False Claims Act, reversing a lower court that had dismissed his action. The Third Circuit’s opinion appropriately recognizes that a whistleblower can use non-public information as a bridge between public information and allegations of fraud, without triggering the public disclosure bar. Although...

November 8, 2016

Niurka Fernandez and her son Roberto Alvarez were sentenced to 120 months and 30 months in prison, respectively, for their roles in spearheading a $9.5 million health care fraud conspiracy that targeted Medicare Part D.  In addition, Fernandez and Alvarez were ordered to pay respectively $9.5 million and $1.5 million in restitution and to forfeit the same amounts.  As part of her guilty plea, Fernandez admitted she co-owned and operated several pharmacies in the Miami area, including Calan Pharmacy & Discount Service LLC and Bertyann Corp. (doing business as Best Pharmacy), for the purpose of submitting false and fraudulent claims through Medicare Part D by paying kickbacks to Medicare beneficiaries and patient recruiters for prescriptions that were medically unnecessary.  DOJ

November 13, 2015

Tamara Esponda, owner of Miami-area pharmacy Biomax Pharmacy Inc., was sentenced to 42 months in prison and to pay roughly $1.6 million in restitution for her role in the submission of more than $1.5 million in fraudulent claims to Medicare Part D.  According to admissions made in connection with Esponda’s guilty plea, Biomax Pharmacy submitted fraudulent claims to Medicare for prescription drugs that were not prescribed by physicians, not medically necessary and not provided to Medicare beneficiaries.  Esponda further admitted that in perpetrating this fraud she and her accomplices used the beneficiaries’ and doctors’ Medicare identification numbers without their consent.  DOJ

August 3, 2015

Rouzbeh Javaherian, owner of Los Angeles-based Westaid Pharmacy and Medical Supply, was sentenced to 18 months in prison and to pay $644,060 in restitution for his role in a fraud scheme involving the Medicare Part D prescription drug program.  Specifically, Javaherian paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid.  Javaherian then filled some of those prescriptions, but also submitted false claims to Medicare Part D plan sponsors for prescriptions that he did not actually fill.  DOJ

March 16, 2015

Los Angeles pharmacist Rouzbeh Javaherian pleaded guilty to defrauding the Medicare Part D program through his pharmacy called Emoonah Inc. (d/b/a Westaid Pharmacy and Medical Supply).  Specifically, he paid illegal cash kickbacks to Medicare beneficiaries to induce them to submit their prescriptions to Westaid and he submitted fraudulent claims to Medicare Part D plan sponsors for prescriptions he did not actually fill.  DOJ

Congress Highlights Medicare Part D Plans’ Failure To Prevent Fraud

Posted  07/16/15
By Tim McCormack and Molly Knobler Fraud in the Medicare Part D prescription drug program is getting the attention of not only the Department of Health and Human Services’ Office of the Inspector General (HHS OIG) but also watchdogs on Capitol Hill.  On Tuesday, July 14, 2015, the House of Representatives’ Committee on Energy and Commerce held a hearing to examine two recent reports from HHS OIG examining improper spending in...

CVS Sub Caught Duping Consumers in Prescription Drug Purchases

Posted  10/22/12
By Marlene Koury In one of the first False Claims Act settlements involving Medicare's "Part D" prescription drug program, CVS Caremark subsidiary, RxAmerica, agreed to pony up $5.25 million to resolve charges that it submitted false pricing information to the Centers for Medicare & Medicaid Services (CMS).  This is the government body that oversees the Medicare and Medicaid programs.  It also makes available the Internet-based tool called Plan Finder which...

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