Pharma Fraud

April 20, 2017

Illinois-based drugstore giant Walgreen Co. agreed to pay $9.86 million to resolve allegations it violated the False Claims Act by submitting claims for reimbursement to California’s Medi-Cal program that were not supported by applicable diagnosis and documentation requirements. The allegations originated in a whistleblower lawsuit filed under the qui tam provisions of the False Claims Act by a former Walgreens pharmacist and a former pharmacy technician. They will receive a whistleblower award of roughly $2.3 million from the proceeds of the government's recovery. DOJ (EDCA)

April 2, 2017

Sanofi-Pasteur agreed to pay roughly $20 million to resolve claims it incorrectly calculated drug prices and thereby overcharged the U.S. Department of Veterans Affairs for drugs under two contracts between 2002 and 2011. DOJ

April 20, 2017

California announced a $9.8 million settlement with Walgreens, one of the largest drugstore chains in the United States. The settlement involved allegations that Walgreens failed to adhere fully to requirements imposed by California law for the dispensing of certain prescriptions drugs under Medi‑Cal. The settlement is the result of lawsuits filed by whistleblowers and investigated and resolved by federal and state prosecutors. The lawsuits alleged that for more than five years, Walgreens falsely certified that it had complied with diagnosis-related requirements for the lawful dispensing of prescriptions to Medi‑Cal patients. Through the Bureau of Medi‑Cal Fraud and Elder Abuse (BMFEA), the Attorney General’s office regularly works with whistleblowers and law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi‑Cal program. False claims lawsuits pursued by the Attorney General in the last two years have recovered tens of millions of dollars from some of the nation’s largest pharmaceutical companies for allegations of improper marketing, falsifying reports to inflate prices, and other wrongful practices. CA

March 2, 2017

New York announced the sentencing of two pharmacy owners, a supervising pharmacist and ten corporations for defrauding several government-funded healthcare programs, including Medicaid and Medicare. An investigation revealed that on at least eight separate occasions between November 2013 and February 2014, the defendants paid patients hundreds of dollars in cash to forgo their prescription medications, the vast majority of which were to treat HIV. The defendants then submitted false claims to Medicare, Medicaid and Medicaid-managed care organizations and were reimbursed for distributing the medications, despite the fact that they were never dispensed to patients. Tarek Elsayed, 50, of Elmhurst Queens, the co-owner of 184th Street Pharmacy in the Bronx, was sentenced in Bronx County Supreme Court by the Honorable Stephen Barrett to one to three years in state prison. Previously, in August of 2016, Ahmed Hamed, 39, of Elmhurst Queens, the second co-owner of 184th Street Pharmacy, was sentenced to two to six years in state prison. In October of 2016, Mohamed Hassan Ahmed, 38, of Bayside, the supervising pharmacist at 184th Street Pharmacy, was sentenced to one to three years in state prison and was required to surrender his license to practice pharmacy. Collectively, the three defendants stole over $10 million from government-funded health care programs. In addition, the Attorney General’s Medicaid Fraud Control Unit (MFCU) reached a $4.1 million civil settlement agreement with defendant Elsayed and a $3.8 million civil settlement agreement with defendant Hamed. NY

January 24, 2017

A former Poplar Grove, Illinois woman pleaded guilty in federal court in Rockford, Illinois to mail fraud and aggravated identity theft. According to documents filed with the court, from 2012 through 2014, Shameka Carr, 30, used individuals’ names, social security numbers and dates of birth without their knowledge or consent to file fraudulent income tax returns. Carr directed the fraudulently claimed refunds to prepaid debit cards and refund checks which she had mailed to addresses in Rockford and its surrounding areas. Carr admitted to an intended tax loss of $1,026,284. DOJ