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Pharma Fraud

This archive displays posts tagged as relevant to pharmaceutical fraud. You may also be interested in our pages:

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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

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

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

April 21, 2022

Susan H. Poon, 57, will spend 70 months in federal prison, and will pay nearly $1.4 million in restitution for a scheme spanning over 3 years, and which resulted in approximately $2.2 million in fraudulent billings. Poon submitted prescriptions both with PII obtained at health fairs held by Costco and UPS, and by soliciting information from actual patients about their dependents—dependents whom Poon never saw or treated. Poon used the stolen PII to submit fraudulent durable medical equipment prescriptions to a DME manufacturer, who then unknowingly submitted false claims for reimbursement to a health insurer. In addition to the prison sentence and the owed restitution, Poon’s chiropractic license was revoked in 2019. USAO CDCA

Gordon Schnell and Max Voldman Published in Newsweek on How Whistleblowers are Key to Reining in Prescription Drug Costs

Posted  04/21/22
Newsweek published an OpEd by Constantine Cannon whistleblower lawyers Gordon Schnell and Max Voldman on the need to expand the Medicaid Drug Rebate Program to Medicare.  The piece was prompted by DOJ's recent $235 million settlement with U.K. and St. Louis-based pharma company Mallinckrodt for allegedly violating the Medicaid rebate rule. On the books since 1990, the rule requires drug companies to rebate state...

April 13, 2022

Pharmacy owner Aleah Mohammed was sentenced to 78 months in prison for stealing more than $6.5 million from the government via her prescription fraud on Medicare and Medicaid drug plans. Mohammad submitted claims for drugs that weren’t dispensed, weren’t prescribed as claimed, were not medically necessary, or that were dispensed while the pharmacy was no longer registered with the State of New York. The proceeds were used by Mohammed and her family members to buy luxury vehicles, jewelry, and properties in Queens and Pocono Pines, Pennsylvania. USAO EDNY

March 7, 2022

Pharmaceutical company Mallinckrodt ARD LLC will pay $260 million to resolve allegations that it violated the False Claims Act in the sale and marketing of its drug H.P. Acthar Gel.  The government intervened in whistleblower actions alleging that Mallinckrodt and its predecessor Questcor Pharmaceuticals Inc. knowingly underpaid state Medicaid programs by improperly calculating amounts it owed under the Medicaid Drug Rebate Program, and unlawfully used a foundation as a conduit to subsidize co-payments.  With respect to the Medicaid rebate claims, which represent $234.7 million of the settlement, defendants were alleged to have calculated rebate amounts as if Acthar was a “new drug” first marketed in 2013, rather than a drug that had been approved since 1952.  By using 2013 for Acthar’s Base Date Average Manufacturer Price (AMP), the company ignored price increases prior to 2013 and fraudulently reduced Acthar drug rebates.  With respect to the copayment fraud claims, which represent $26.3 million of the settlement, defendants were alleged to have violated the Anti-Kickback Statute by subsidizing copayments through payments to three funds that Mallinckrodt had a foundation set up to induce Medicare-reimbursed purchases of Acthar, using the subsidies to counteract doctor and patient concerns about the drug’s high cost.  The whistleblower in the Medicaid rebate case, James Landolt will receive an award of $24.7 million, representing 20% of the $123.6 million federal share of that settlement; the relator’s share for the state share of the settlement was not announced.  The whistleblowers in the copayment case, Charles Strunck and Lisa Pratta, will receive an award of $4.9 million, representing 19% of that settlement.  The settlement includes a five-year corporate integrity agreement (CIA) with monitoring provisions.  DOJ; USAO MA; USAO EDPA

January 28, 2022

Hayat Pharmacy agreed to pay over $2 Million to resolve allegations that it submitted false claims to Medicare and Medicaid for certain prescription medications from its 23 locations. The government alleged Hayat Pharmacy submitted false claims for two prescription medications, a topical cream consisting of iodoquinol, hydrocortisone, and aloe, and a multivitamin with the trade name Azesco.  Hayat Pharmacy allegedly switched Medicaid and Medicare patients from lower cost medications to the higher cost medications without any medical need and/or without a valid prescription. As part of the settlement, Hayat Pharmacy agreed to conduct annual training concerning waste, fraud and abuse, and compliance with rules concerning medication switches. USAO WI

Top Ten Healthcare Fraud Recoveries of 2021

Posted  01/11/22
doctor holding stethoscope
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2021 stemmed from healthcare fraud matters. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False Claims Act. The majority of the recoveries on this list involve allegations of violations of the Anti-Kickback Statute, a federal law that...

Catch of the Week: Jury Finds Teva Pharmaceuticals Liable for Contributing to Opioid-Related Deaths in New York State

Posted  01/7/22
spilt pills
In a significant development in the ongoing effort to assess blame and responsibility for the opioid epidemic, which has led to the deaths of hundreds of thousands of individuals and ravaged communities throughout the United States, on December 30th, after a six-month trial, a New York jury found that Teva Pharmaceuticals USA, Inc. (“Teva”) and its affiliates, including Anda Inc., created a “public nuisance”...
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