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Pharma Fraud

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Catch of the Week – Justice Department Sues Tennessee Pharmacies and Pharmacists Illegally Dispensing Opioids

Posted  02/11/19
On Friday, the Justice Department announced that it has sued several pharmacies and pharmacists in Tennessee to stop them from illegally dispensing opioids. According to the complaint, both defendants have “fueled and profited from” the opioid epidemic by “repeatedly dispensing opioids and other controlled substances prone to abuse without a legitimate medical purpose and outside the usual course of professional...

February 6, 2019

Abbott Labs has agreed to pay a total of $25 million to settle allegations of paying kickbacks to healthcare professionals in exchange for promotion of its drug, and inappropriately marketing its drug, TriCor, for cardiovascular events not approved by the FDA. The case was initiated by the State of North Carolina and joined by California, Illinois, Nevada, Maryland, Michigan, and Texas, as well as the federal government. NC AG

February 4, 2019

Compounding pharmacy Pentec Health, Inc., which sells a drug Proplete for nutrition support for patients with end stage renal disease, has agreed to pay $17 million to settle claims under the False Claims Act.  Pentec was alleged to bill federal healthcare programs for product wasted during the compounding of Proplete, and for Proplete that was not medically necessary or was not actually received by patients, routinely waiving patient copays and deductibles to induce the prescription of the drug.  Pentec also entered into a corporate integrity agreement and will be excluded from participation on federal healthcare programs.  The case was initiated by whistleblower Jean Brasher, a former employee of Pentec, who will receive an undisclosed share of the settlement. USAO EDPA

Catch of the Week – Walgreens Pays Record $273 Million To Settle Three FCA Suits

Posted  01/25/19
Three separate qui tam actions brought by whistleblowers against Walgreens Boots Alliance, Inc. (Walgreens) have resolved in what amounts to the largest settlement payouts for a retail pharmacy. In the first action, two former Walgreens pharmacists alleged that the company sought reimbursement for insulin pens it dispensed to Medicare and Medicaid beneficiaries who did not need them. Walgreens did so in two ways....

January 22, 2019

Walgreens Co. will pay the U.S. and the State of Wisconsin $3.5 million to settle a case under the False Claims Act alleging that the retail pharmacy routinely dispensed stimulant medications to Wisconsin Medicaid beneficiaries without first verifying that the prescribing physician ordered the medication for medically appropriate treatment, such as treatment for attention deficit disorder. The case was initiated by unidentified whistleblowers, who will receive a share of the settlement to be determined. USAO EDWI

January 22, 2019

Walgreens Boots Alliance, Inc. will pay $60 million to settle a False Claims Act case brought by a whistleblower alleging that the retail pharmacy chain knowingly overcharged Medicaid when it charged the healthcare program more than "usual and customary price" for medications that participants in Walgreens "Prescriptions Savings Club" received at a lower price.  Of the settlement, approximately $32 million will be paid to the U.S. and $28 million to the affected states.  Whistleblower Marc D. Baker will receive a share of the total settlement, to be determined at a later date.  USAO SDNY

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

Top Ten Healthcare Recoveries of 2018

Posted  01/15/19
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2018 stemmed from healthcare fraud matters. And again, most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. Here are the top ten healthcare recoveries of 2018 by the numbers:
    1. Amerisource Bergen Corporation - In...

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

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    
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