August 29, 2013 — Violations of the False Claims Act involving health care fraud rob U.S. taxpayers of dollars that are needed elsewhere. Each year, conscientious insiders working in the health care industry file qui tam lawsuits that are instrumental in helping federal authorities to combat Medicare and Medicaid fraud. The False Claims Act’s qui tam provisions allow whistleblowers to bring a lawsuit for the benefit of the government and to share in the government’s judgment or settlement.
Pharmacy Allegedly Billed Medicare for Controlled Substances Dispensed Without a Prescription
A Kentucky-based pharmacy services company has been sued by the U.S. Department of Justice (DOJ) in a False Claims Act suit for allegedly overcharging Medicare. PharMerica Corp. (PharMerica) operates pharmacies at skilled nursing facilities and in nursing homes. The DOJ has alleged that PharMerica dispensed drugs without a prescription, even though a prescription was required, and then billed Medicare for the drugs.
PharMerica pharmacists allegedly fill 40 million prescriptions annually for 300,000 patients in nursing care facilities. Many of PharMerica’s patients require medications listed in the Controlled Substances Act that can only be distributed with a physician’s prescription. Controlled substances are classified differently, depending on the potential harm to patients. Drugs listed on Schedule II include fentanyl and oxycodone, both of which are dangerous if taken in doses other than the prescribed amounts. According to the DOJ, PharMerica provided nursing staff with Schedule II drugs without a physician’s prescription.
PharMerica allegedly submitted false claims to Medicare knowing that the claims were ineligible for reimbursement because the drugs had been illegally dispensed. The False Claims Act case was initiated by whistleblower Jennifer Denk, who sued PharMerica on behalf of the government in 2009. Two other whistleblowers, Eric Beeders and Lesa Martino, filed False Claims Act lawsuits against PharMerica in 2010. The complaints of the three whistleblowers were consolidated into the complaint filed by the DOJ. If the government is successful in the lawsuit, the whistleblowers may be entitled to a significant share of the amount recovered.
Health Care Insiders Stop Medicaid Fraud With False Claims Act Suits
Health care whistleblowers who are thinking about collaborating with the government should become informed about the False Claims Act and the rights provided by the statute. The qui tam lawyers at Waters & Kraus are keenly focused on protecting informants’ rights. Contact us by email or phone our whistleblower attorneys at 855.784.0268 to discuss our health care fraud practice and what we can do to advance your interests.