A 2015 whistleblower fraud case filed by Uri B., a resident of Albuquerque and pharmacist employed by Omnicare was recently formally taken up by the U.S. Government, according to a New York Times article. Omnicare is purchased for $10.4 billion that same year by the large drugstore chain CVS which is headquartered in the State of Rhode Island.

Under the federal False Claims Act, American citizens are empowered to be the “eyes and ears” of the government and file legal claims on its behalf when it comes to fraudulent claims against publicly funded programs. The person initiating the action in a whistleblower fraud case is referred to as a relator. If the U.S. Department of Justice (DOJ) feels the allegations have merit and wants to investigate and “take up the mantle” of the case by pursuing recovery, the relator is rewarded with a percentage of the funds regained.

The Allegations against Omnicare

The allegations in this whistleblower fraud case concern inappropriate billing of public health programs such as Medicaid, Medicare, and Tricare—the medical insurance program for military personnel. Purportedly, patients in the tens of thousands were on the receiving end of a dispensary machine in which expired or “no refill remaining” prescriptions were renewed under newly assigned numbers, allowing for false claims against the public health programs.

The patients were less likely to be aware of the fraud because the vast majority of them were compromised by age or mental and physical status. As indicated by a separate report posted by Fox Business News on the same day, the patients involved were either senior residents of assisted living facilities or adults living in long term care clinics or special needs group homes.

For an eight-year window running from 2010 to 2018, this practice of rolling over prescriptions with new numbers allowed Omnicare to continue to secure massive payouts from the U.S. government. The very dangerous side of this alleged criminal activity was to put patients at risk by allowing a continuance of medication without the valid oversight of the originally prescribing physicians.

The drugs, according to the International Business Times, most often belonged to drug classes that acted on the brain and central nervous systems such as anticonvulsants, antidepressants, and antipsychotics. The drugs in these categories can come with risky side effects which can even be life-threatening.

The civil complaint by the DOJ was filed in Manhattan Federal Court this month and seeks civil penalties and damages. At this point in time, there is no move by CVS to settle the case as it maintains the integrity of Omnicare’s dispensing activities. A spokesperson for CVS Health Corp. has claimed in a statement that the organization has confidence their practices have fallen within the accepted range of state law and industry norms, according to our New York Times source.

Additionally named plaintiffs include 29 U.S. States and the District of Columbia.

This article is not legal advice. It is presented
for informational purposes only.