Former Walgreens manager to be sentenced in fraud case

November 2, 2016

The charges involve falsified claims for expensive hepatitis C medications.

A former Walgreens clinical pharmacy manager faces up to 10 years in prison and a $250,000 fine when sentenced next year on fraud charges involving falsified claims for expensive hepatitis C medications.

On Oct. 25, 2016, Amber Reilly, 33, of Jonesborough, Tenn., pled guilty to one count of healthcare fraud before U.S. District Judge J. Ronnie Greer in Greeneville, Tenn. Reilly, formerly the clinical pharmacy manager at the Walgreens Specialty Pharmacy in Kingsport, Tenn., is scheduled to be sentenced on Jan. 30, 2017.

Editor’s Choice: PBMs, insurers strike deals for Hep C drugs

According to prosecutors, between October 2014 and April 2016, Reilly falsified prior authorizations, medical lab reports, and drug test results for more than 50 patients with prescriptions for costly hepatitis C medications.

Without the bogus paperwork, the patients’ insurance would not have covered expensive medications such as Solvaldi, Harvoni, Veikira Pak, or Daklinza.

The patients in question were insured through TennCare, which does not pay for hepatitis C prescriptions for patients who either abuse illicit substances or who have limited or no scarring of the liver.

Prosecutors alleged that the patients’ authentic lab reports and drug tests would have made them ineligible for insurance coverage for the expensive medications.

 

Reilly confessed to changing lab reports and falsifying information on claims for they would be approved. While pharmaceutical companies have made great advances in the treatment of hepatitis C, many insurance companies will not cover the costly medications.

“Reilly admitted to replacing disqualifying information regarding levels of liver scarring and illicit substance abuse on the authentic records with qualifying information, and then submitting the altered records to TennCare,” according to a statement from prosecutors.

“She also admitted to fabricating allergies on the prior authorization forms of some of these patients so they could receive the most expensive hepatitis C drug, Harvoni,” prosecutors stated.

As a result, prosecutors said TennCare paid at least $4.4 million it should not have paid for the medications.