Pharmacy to pay $8 million to settle fraudulent billing allegations

A Florida compounding pharmacy has agreed to pay $8 million to settle allegations it billed the federal government for improper and medically unnecessary prescriptions.

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Prosecutors alleged that Blanding Health Mart Pharmacy of Jacksonville, Fla., between Feb. 9, 2015 and April 13, 2015, sought reimbursement for compounded prescriptions that were not medically necessary and were written by physicians that had never actually seen the patients. Blanding agreed to pay $8,441,107 to resolve the allegations.

“This case was developed as part of a broader effort by our office to identify and target unscrupulous compounding pharmacies,” said U.S. Attorney A. Lee Bentley. “Since the beginning of the year, we have been focusing on pharmacies that have abused the TRICARE program and defrauded the government.”

The Defense Criminal Investigative Service of the Department of Defense (DoD), the Federal Bureau of Investigation, the Defense Health Agency Program Integrity Office, and the United States Attorney investigated the case.

 "Fraud and abuse by pharmacies and medical providers which bill for compounded pain prescriptions is a significant threat to the DoD healthcare system,” said John F. Khin, a DoD special agent in charge. “TRICARE beneficiaries must be made aware that any medications that are not individually prescribed or dispensed by a bona fide treating physician for a specific medical condition can be ineffective or unsafe."

Since January 2009, the federal government has recovered more than $24 billion through False Claims Act cases; $15.3 billion of that total involved fraud against federal healthcare programs.

Last month, another Jacksonville, Fla. pharmacy agreed to pay a $3.775 million to settle charges it knowingly billed the government for compounding prescriptions that came from an improper referral source.

In that case, MediMix and referring physician Ankit Desai submitted hundreds of claims to TRICARE that were not reimbursable because Desai was married to a senior vice president at MediMix.