Monthly Archives: May 2015

PharMerica to Pay $23.5 Million to Settle False Claims Act Lawsuit

Written May 18, 2015 by Robert Lu

On Thursday, May 14, 2015, the U.S. Justice Department announced that PharMerica Corporation has agreed to pay the United States $23.5 million to resolve a lawsuit alleging that it violated the False Claims Act by submitting false claims to Medicare for Schedule II controlled substances without first obtaining the necessary physician prescription showing a medical need.   A separate part of the lawsuit, and settlement, resolved allegations that PharMerica violated the Controlled Substances Act. That portion of the lawsuit was resolved for $8 million.

PharMerica is a long-term care pharmacy that dispenses medications to residents of long-term care facilities, including nursing homes and skilled nursing facilities. Many of the prescriptions filled by PharMerica are for controlled substances listed in Schedule II under the Controlled Substances Act. Schedule II drugs, such as oxycodone and fentanyl, can cause significant harm if used improperly and have a high potential for abuse. The lawsuit alleged that that PharMerica submitted false claims to Medicare for drugs dispensed without valid prescriptions in violation of the Controlled Substances Act.
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Sixteen Hospitals Agree to Pay the United States Nearly $16 Million to Resolve False Claims Act Allegations of Submitting Claims for Medically Unnecessary Psychiatric Procedures

Written May 7, 2015 by Robert Lu

On May 7, 2015, the U.S. Justice Department announced that 16 separate hospitals (as well as their respective corporate parents) have agreed to collectively pay nearly $16 million to resolve allegations that they sought and received reimbursement from Medicare for medically unnecessary or unreasonable services in violation of the False Claims Act.

This case involves a procedure called Intensive Outpatient Psychotherapy (IOP). IOP services represent a continuation of ambulatory psychiatric services and provide active treatment to individuals with mental disorders. Medicare generally pays for an appropriate course of IOP treatment provided a number of specific requirements are satisfied including, most notably, that the services in question are reasonable and necessary for the diagnosis and treatment of the patient’s condition.
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