Pharma Fraud

February 2, 2021

The owner of Mississippi-based Medworx Compounding and Custom Care Pharmacy, Marco Bisa Hawkins Moran, has been sentenced to ten years in prison and ordered to pay $34.3 million in fines and restitution following his guilty plea on charges related to a conspiracy to defraud TRICARE and other healthcare programs.  As part of the scheme, which resulted in the submission of $22.1 million in fraudulent claims, Moran and his co-conspirators adjusted prescription formulas to ensure the highest reimbursement, paid marketers and physicians kickbacks and bribes to obtain prescriptions for high-yield compounded medications without regard to medical necessity, and routinely waived and/or reduced the collection of copayments. USAO SD MS

December 17, 2020

Pharmaceutical company Biogen Inc. agreed to pay $22 million, and specialty pharmacy Advanced Care Scripts agreed to pay $1.4 million, to resolve claims that they conspired to use two foundations, the Chronic Disease Fund and The Assistance Fund, as conduits to pay Medicare co-payments for patients taking Biogen’s MS drugs, Avonex and Tysabri, in violation of the Anti-Kickback Statute.  The government alleged that Biogen coordinated with ACS to time its payments to the foundations and direct its money to cover co-pay costs for patients using its drugs.  DOJ; USAO MA

November 2, 2020

Hospital system Memorial Health Services will pay a total of $31.5 million after self-disclosing that it overcharged California’s Medicaid program, Medi-Cal, for outpatient prescription drug reimbursements under the 340B Drug Pricing Program.  Memorial Health billed Medi-Cal for outpatient drugs at its usual and customary rate, rather than the lower “actual acquisition costs,” as required under the 340B Drug Pricing Program. California will receive $18.9 million of the settlement, and the federal government will receive $12.6 million.  Cal; CD Cal

October 21, 2020

Purdue Pharma LP agreed to criminal fines and forfeitures totaling $5.544 billion following its guilty plea on charges arising from its manufacture and sale of opioid products.  Purdue falsely represented to the DEA that they maintained an effective anti-diversion program while continuing to market opioid products to healthcare providers that it had reason to believe were diverting opioids, aided and abetted the dispensing of opioids without a legitimate medical purpose, paid doctors to induce them to prescribe Purdue’s products, and paid an EHR company to boost the presence of Purdue’s products on the EHR system.  Purdue will receive a credit of up to $1.775 billion based on its prior settlements with state and local entities.  In addition to the criminal fines and forfeitures, a civil settlement provides the U.S. with an allowed claim of $2.8 billion to resolve claims that the company caused the submission of false claims to federal healthcare programs.  Individual members of the Sackler family, which owns Purdue, separately agreed to pay $225  million to resolve claims arising from their approval of a marketing program aimed at extreme high-volume prescribers and their transfer of assets into Sackler family holding companies and trusts.   DOJ