U.S. Sues CVS for Fraudulently Billing Medicare, Medicaid for Invalid Prescriptions

U.S. Sues CVS for Fraudulently Billing Medicare, Medicaid for Invalid Prescriptions

https://www.nytimes.com/reuters/2019/12/17/us/17reuters-cvs-lawsuit.html

NEW YORK — CVS Health Corp and its Omnicare unit were sued on Tuesday by the U.S. government, which accused them of fraudulently billing Medicare and other programs for drugs for older and disabled people without valid prescriptions.

The Department of Justice joined whistleblower litigation accusing Omnicare of violating the federal False Claims Act for illegally dispensing drugs to tens of thousands of patients in assisted living facilities, group homes for people with special needs, and other long-term care facilities.

According to a civil complaint filed in Manhattan federal court, Omnicare would often assign new numbers to prescriptions after the original prescriptions expired or ran out of refills.

The government said this enabled Omnicare to bill Medicare Medicaid, and Tricare, which serves military personnel, for hundreds of thousands of drugs, under what the company internally called “rollover” prescriptions, from 2010 to 2018.

Many of the drugs were anticonvulsants, antidepressants and antipsychotics and treated serious conditions such as dementia, depression and heart disease, and sometimes had dangerous side effects requiring supervision by doctors, the government said.

“A pharmacy’s fundamental obligation is to ensure that drugs are dispensed only under the supervision of treating doctors who monitor patients’ drug therapies,” U.S. Attorney Geoffrey Berman in Manhattan said in a statement.

“Omnicare put at risk the health of tens of thousands of elderly and disabled individuals living in assisted living and other residential long-term care facilities,” he added.

The lawsuit seeks civil penalties and other damages.

CVS, one of the largest U.S. drugstore chains and pharmacy benefit managers, said it did not believe the claims had merit, and that it intended to defend itself in court.

“We are confident that Omnicare’s dispensing practices will be found to be consistent with state requirements and industry-accepted practices,” the company said in a statement.

CVS, based in Woonsocket, Rhode Island, bought Omnicare in 2015 for about $10.4 billion.

The government joined a lawsuit originally brought in June 2015 by Uri Bassan, a pharmacist who worked for Omnicare in Albuquerque, New Mexico.

It said Omnicare’s compliance department had acknowledged the dispensing problem internally two months earlier, when a regional officer expressed concern in an email that its systems allowed rollover prescriptions “without any documentation or pharmacist intervention.”

The False Claims Act lets whistleblowers sue on behalf of the federal government, and share in recoveries.

Twenty-nine U.S. states and the District of Columbia are also named as plaintiffs.

The cases is U.S. ex rel. Bassan v. Omnicare Inc, U.S. District Court, Southern District of New York, No. 15-04179.

(Reporting by Jonathan Stempel in New York; Editing by Chizu Nomiyama and Bill Berkrot)

This article is confusing to me… particularly about the issue involving long term care (Nursing homes)

I used to work as a temp for 5-6 yrs at one of the Omnicare’s pharmacy/distribution centers and I also served a few nursing homes when we had our own independent pharmacy.

Nursing homes don’t work on “prescriptions” – except for controlled substances – they work on physician orders.  Most nursing homes have two levels of care ICF (intermediary care facility) or SNF (skilled nursing facility) .

As I remember a ICF pt has to have their med orders reviewed and signed every 60 days by their physician and a SNF pt has to have that done every 30 days.

When it came to controlled meds Rxs… we could no longer take orders from the nursing staff in the nursing home… per the DEA they were no longer consider a legal agent of the prescriber.

The Pharmacist would call or text the prescriber, generally there was just a couple of prescribers – one being the medical director for the home – that cared for all the pts in the home..   We got on a first name basis with most of these prescribers… and we would tell the doc that Mrs Smith’s prescription for this controlled med and the prescriber would authorize us to rewrite it and typically put the max number of refills as allowed by law.

If a C-II med was involved, the technician in the control room tracked that the prescriber got a signed Rx back to the pharmacy within 10 days.  The flow was pretty much very well organized and tracking to make sure that all the “i’s” were dotted and “t’s” were crossed…

I retired from working in pharmacy mid -2013 so I don’t know what changes that CVS had implemented since they acquired Omnicare in 2015, but this whistle blower case goes back to 2010. The 5 or 6 years that I worked as a temp at Omnicare… other distribution centers had some paperwork issues with the DEA but the center I worked at must have been much better organized and had all their ducks in a row.

 

 

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