A lawsuit has been filed against Omnicare and parent company CVS Health alleging prescription drug fraud in the dispensing of drugs to senior citizens in assisted living and other facilities.
The Department of Health and Human Services – Office of the Inspector General filed the civil healthcare fraud lawsuit on December 17.
CVS acquired Omnicare in May 2015, and shortly thereafter assumed an active role in overseeing its operations, including pharmacy dispensing practices and systems, according to the AG’s office.
Omnicare allegedly fraudulently billed federal healthcare programs for hundreds of thousands of non-controlled prescription drugs dispensed based on stale, invalid prescriptions to elderly and disabled individuals in assisted living facilities, group homes, independent living communities and other non-skilled residential long-term care facilities, according to the Government’s Complaint that seeks damages and civil penalties under the False Claims Act.
Senior Omnicare and CVS management allegedly 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 investigation, according to Geoffrey S. Berman, the United States Attorney for the Southern District of New York, and Scott J. Lampert, Special Agent in Charge of the New York Regional Office of the HHS-OIG.
In addition, Omnicare knowingly transmitted false information to Medicare, Medicaid and TRICARE that made it appear that drug dispensations were supported by current, valid prescriptions from physicians when in fact they were not, the complaint said.
WHY THIS MATTERS
Omnicare’s practice exposed vulnerable individuals to a significant risk of harm, the complaint said.
Many of the drugs treat serious, chronic conditions, such as dementia, depression, and heart disease. They include antipsychotics, anticonvulsants, cardiovascular medications and antidepressants.
Omnicare jeopardized the health of thousands of individuals who continued to take the same drugs for months, and sometimes years, without consulting their doctors to determine whether the medications were still clinically appropriate, the complaint said.
In contrast to traditional skilled nursing homes, where residents have access to 24-hour medical care supervised by doctors, assisted living and other non-skilled residential facilities generally do not have doctors on staff to oversee and monitor residents’ drug therapy.
The lawsuit alleges that Omnicare failed to obtain new prescriptions from patients’ doctors after the old ones had expired or run out of refills. Instead, Omnicare assigned a new number to the old prescription. Omnicare internally referred to these as “rollover” prescriptions. The company sometimes allegedly assigned a fake number of authorized refills to a prescription – usually 99 allowable refills for Medicare patients – to allow for continuous refilling. Many pharmacies had to process and dispense thousands of orders each day.
THE LARGER TREND
Omnicare is the country’s largest provider of pharmacy services to long-term care facilities, operating approximately 160 pharmacies in 47 states across the country, according to the complaint.
Every year, Omnicare dispenses tens of millions of prescription drugs to long-term care and other facilities.
The government intervened in two private whistleblower lawsuits that had previously been filed under seal pursuant to the False Claims Act.
ON THE RECORD
Manhattan U.S. Attorney Geoffrey S. Berman 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. Omnicare blatantly ignored this obligation in favor of pushing drugs out the door as quickly as possible to make more money.”
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com