Articles Tagged with prescription drugs

IMG_0403-300x169On Tuesday, August 13th, 2019, Peter Frazzano, 46, admitted to participating in a health care fraud scheme involving the submission of fraudulent claims for compounding prescriptions. Frazzano pleaded guilty to conspiracy to commit health care fraud, which is punishable by up to 10 years in prison and a $250,000 fine. Frazzano has also agreed to forfeit over $270,000 and pay a restitution fee of nearly $3 million.

According to the Department of Justice, Frazzano and an additional individual involved in the scheme recruited a physician to sign prescriptions for compounding drugs. These prescriptions were ordered for unsuspecting individuals who were never examined or spoken to regarding the drugs.

Once the prescriptions were issued, Frazzano fraudulently billed multiple health insurance organizations, including the New Jersey State Health Benefits plan. The compound prescriptions Frazzano billed these plans for were mainly pain creams, scar creams, and metabolic supplements.

IMG_0355-300x201Michael Burton, of Decatur, Georgia, was sentenced to 96 months in federal prison for his participation in a scheme that defrauded TRICARE and other insurers a combined $6.5 million. According to the Department of Justice, Burton plead guilty to charges of conspiracy to commit health care fraud, conspiracy to commit money laundering, and money laundering.

From 2014 to 2015, Burton and his team of conspirators defrauded TRICARE and other private insurance companies through the submission of fraudulent claims for prescriptions including scar creams, pain creams, and wellness capsules. Sales representatives were recruited to obtain personal and insurance coverage information from individuals in exchange for commission payments. Co-defendant, Brad Hodgson, would then use the information to prescribe the compounded drugs without a necessary medical purpose. These individuals were not the patients of Hodgson, and he was not licensed to write prescriptions.

Once the prescriptions were forged, fraudulent claims for the reimbursement of these drugs were submitted to TRICARE and other insurers. These claims totaled $6.5 million, with Burton’s participation in the scheme profiting him a total of $1.4 million in the form of commission payments.

prescription drugsWith the increased frustration regarding inflated prescription drug prices, states like Florida are pushing for legislative programs that would permit the United States to import drugs from Canada. If this bill were to pass, it would allow many of the identical prescription drugs consumed by Americans to be purchased for a third of the price. However, this is not the first time a bill of this nature has been attempted.

In Utah, a similar bill that would have allowed the state to import prescription drugs from Canada was eventually turned down after lawmakers spent two-years developing the legislation. However, representatives in the state of Utah have not given up and claim that they will try a variation of the bill again next year. Leading the original legislation, as well as the upcoming bill is Republican Representative Norman Thurston.

However, the state of Florida is the next in the line to attempt to pass a similar version of this bill, which would permit the importation of prescription drugs for both Medicaid and prisoners. If passed, an additional program of the legislation would also allow the importation of these products for residents of the state.

prescription drugKmart Corporation, a wholly owned subsidiary of Sears Holdings Corporation (SHC), has agreed to pay $32.3 million to the United States to settle allegations that in-store pharmacies in Kmart stores failed to report discounted prescription drug prices to Medicare Part D, Medicaid, and TRICARE.

The False Claims Act lawsuit, which was filed in 2008 by James Garbe, alleged that Kmart pharmacies offered discounted generic drug prices to cash-paying customers through various club programs but knowingly failed to disclose those prices when reporting to federal health programs its usual and customary prices, which are typically used by those programs to establish reimbursement rates.

“Pharmacies that are not fully transparent about drug pricing can cause federal health programs to overpay for prescription drugs.” said Acting Assistant Attorney General Chad A. Readler for the Department’s Civil Division. “This settlement should put pharmacies on notice that there will be consequences if they attempt to improperly increase payments from taxpayer-funded health programs by masking the true prices that they charge the general public for the same drugs.”