For years, Bernie Lisitza owned small pharmacies in the Chicago area. He eventually traded his dual role as owner and pharmacist and went to work for Omnicare, which dispenses prescriptions for nursing homes throughout the country.
For years, Bernard Lisitza owned small pharmacies in the Chicago area. He eventually traded his dual role as owner and pharmacist and went to work for Omnicare, which dispenses prescriptions for nursing homes throughout the country.
There, he discovered that Omnicare routinely switched Medicaid patients’ prescriptions for more expensive ones. He confronted his supervisors and was fired. He then began working as a temp at local pharmacies, where he found that CVS and Walgreens were also switching patients’ prescriptions without authorizations.
Troubled by the practice, Lisitza filed Medicaid fraud qui tam lawsuits against Omnicare, CVS, and Walgreens, alleging all 3 were switching patients’ prescriptions without authorizations in order to increase profits and cheat state Medicaid programs.
Between 2006 and 2008, more than $120 million of taxpayer money was recovered from those companies through settlements. Lisitza has been rewarded more than $31 million for the whistleblower information he provided in those cases and a more recent one, according to a report in the Chicago Tribune.
“He’s one of the most successful whistleblowers in uncovering fraud in pharmacies,” Michael Behn, one of Lisitza’s attorneys told the Tribune. “He’s certainly spotlighted the role of pharmacies as gatekeepers to providing government-funded drug benefits to seniors.”
The latest company to agree to a settlement involving fraud was Johnson & Johnson (J&J). In 2007, Lisitza filed suit against J&J accusing the giant drug maker of paying kickbacks to Omnicare to make unauthorized prescription substitutions.
Last week, J&J agreed to pay $149 million to settle the lawsuit. In total, the company paid $2.2 billion to settle Medicaid fraud charges and charges it fraudulently marketed the drug Risperdal for uses not approved by FDA. Previously, Omnicare agreed to pay $98 million to settle charges that it solicited kickbacks from J&J.
In 2008, Walgreens agreed to pay $35 million to settle claims that it improperly switched patients to different versions of ranitidine, fluoxetine, and selegiline to increase reimbursements from Medicaid. Five months earlier, CVS Caremark agreed to pay $36.7 million to settle claims it also improperly switched patients’ prescription to more expensive ones.