Pharma Fraud
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June 5, 2023
Indivior Inc., maker of Suboxone, agreed to a $102.5 million multi-state settlement with 42 state attorneys general for allegedly trying to preserve its drug monopoly by illegally switching the Suboxone market from tablets to film, attempting to destroy the market for tablets. As part of the settlement, Indivior is required to disclose all of the citizen petitions to the FDA, introduction of new products, or if there is a change in corporate control. NC DOJ, CA AG, WA AG, OR DOJApril 14, 2023
Nine defendants will spend a combined 70 years in prison for their respective roles in a $126 million compounding fraud scheme. The co-conspirators defrauded the Department of Labor’s Office of Workers’ Compensation Programs and TRICARE by submitting false claims and paying kickbacks to patient recruiters and physicians for prescribing certain medications, based not on medical necessity but instead on the drugs’ hefty reimbursement rates. The patients received the compounded medications via mail, despite never requesting, wanting, or needing them. DOJMarch 30, 2023
Pharmacist Gisele Nguyen will pay over $3.9 million for fraudulently billing Medicare for medications that were never dispensed. For at least a 5-year period, from 2014 to 2018, Nguyen, dba Natico Pharmacy, submitted fraudulent claims for prescriptions that were never dispensed, and inventory records reflected that the pharmacy did not purchase enough of the medications from wholesalers to meet the fraudulent demand. DOJFebruary 8, 2023
Centene Corporation has agreed to pay $215 million to resolve allegations of violating the California False Claims Act. A government investigation revealed that for almost two years, Centene failed to disclose or pass on discounted prescription drug costs to the state’s Medicaid program, as mandated by program rules, and instead falsely reported higher costs incurred by two of its managed care plans, which together serve beneficiaries in over 20 counties. CA AGFebruary 7, 2023
A startup that operates as an online pharmacy for birth control and contraceptives has agreed to pay $15 million to settle whistleblower claims of defrauding California’s Medicaid program of millions of dollars. In violation of the state False Claims Act, The Pill Club allegedly billed for ineligible services, services not rendered, and enormous quantities of expensive products not ordered by customers. Investigators found that even in cases where customers asked to stop receiving those products, the company continued to dispense enormous quantities and bill the government for them. CA AGJanuary 27, 2023
Walgreen Co. has paid $7 million to settle a False Claims Act lawsuit by the United States and State of Tennessee that alleged the company submitted claims to Tennessee’s Medicaid program for specialty medications that didn’t meet the program’s criteria for coverage. According to the governments’ 2021 complaint, one of Walgreens’ former pharmacists falsified prior authorization requests and records for 65 Medicaid beneficiaries who didn’t meet program requirements. The company then billed TennCare under those false prior authorization requests, and later failed to make repayments even after it discovered its employee’s misconduct. USAO EDTNTop Ten Healthcare Fraud Recoveries of 2022
Posted 01/6/23
