Government Files Lawsuit Against Nation’s Largest Long-Term Care Pharmacy and Its Parent Company for Fraud in Violating False Claims Act
U.S. Attorneys recently announced that the U.S. Department of Health and Human Services, Office of the Inspector General (HHH-OIG) has filed a civil healthcare fraud lawsuit against a large long-term care pharmacy and its parent company. The Government’s Complaint seeks damages and civil penalties under the False Claims Act for fraudulently billing federal healthcare programs for hundreds of thousands of non-controlled prescription drugs dispensed based on assisted living facilities, group homes, independent living communities, and other non-skilled residential long-term care facilities. The illegally dispensed drugs include antipsychotics, anticonvulsants, and antidepressants.
The lawsuit alleges that from 2010 until 2018, the long-term pharmacy failed to obtain new prescriptions from doctors for tens of thousands of elderly and disabled individuals living in long-term care facilities after the old prescriptions had expired or run out of refills. Instead, the pharmacy just assigned a new number to the old prescription and kept on dispensing drugs for months, and sometimes years, after the prescriptions had expired. The pharmacy internally referred to these as “rollover” prescriptions. As set forth in the Complaint, the pharmacy submitted, or caused to be submitted, false claims for payment for these illegally dispensed drugs to Medicare, Medicaid, and TRICARE.
The HHS-OIG Special Agent in Charge said: “Failing to consult doctors as to whether prescriptions should be refilled places patients’ health and medical care at serious risk. These automatic rollover refills could have significant consequences for vulnerable people in long term-care facilities….”
Senior management of the long-term care pharmacy and the parent company both knew that pharmacies were routinely dispensing drugs without valid prescriptions, but they failed to begin to address the problem until after they found out about the HHS-OIG’s investigation.
Compliance Perspective
Allowing the pharmacy used by the facility to continue to provide medications for the residents after prescriptions have expired or the refills have run out without obtaining new physicians’ orders may result in residents receiving medications that are considered unnecessary and even pose significant risks, and may be deemed provision of substandard quality of care, in violation of state and federal regulations.
Discussion Points:
- Review policies and procedures regarding pharmacy services and preventing the illegal dispensing of medications and submission of false claims due to out-of-date or unnecessary prescriptions.
- Train staff about the need for current physician orders for all residents and the danger that providing unnecessary medications to residents poses.
- Periodically audit to determine that all medications provided by the pharmacy and given to residents have current physician orders.
