Friday, September 24, 2021

Will there be a government appeal to a higher court?

 

3 days ago — Compounded drugs are customized medications used by patients with special needs, such as those with allergies to inactive ingredients in FDA-approved products.

"Eleven lots of the compounded intravenous antibiotic Cefazolin have been recalled after manufacturer IntegraDose Compounding Services said there was “a lack of sterility assurance resulting from compounding in a newly installed biologic safety cabinet without completing dynamic smoke study testing.”A recalled antibiotic might not be sterile. That can cause ‘life-threatening’ infections BY DAVID J. NEAL SEPTEMBER 22, 2021 10:15 AM

https://www.miamiherald.com/news/recalls/article254431553.html 

 

2 days ago — Compounded drugs are custom-made medications that traditionally were formulated by state-regulated pharmacies for specific patients. In recent decades, the 

 

2 days ago — On Tuesday, the U.S. Federal District Court for D.C. issued a ruling for summary judgment on behalf of the compounding pharmacies who filed suit against the .

 

12 hours ago — The compounding pharmacies argued that FDA: (1) violated Section 503A by not developing the MOU through regulations; (2) violated the Regulatory Flexibility Act

 

4 days ago — Minneapolis, Minnesota, IntegraDose Compounding Services is voluntarily recalling nine lots, listed in the table below, of cefazolin 2 gram in 20 mL syringe ...

Friday, September 17, 2021

Key DOJ Health-Care Enforcement Trends to Watch Sept. 16, 2021, 3:00 AM

https://news.bloomberglaw.com/white-collar-and-criminal-law/key-doj-health-care-enforcement-trends-to-watch 

South Hills Pharmacist Pleads to Health Care Fraud Conspiracy, Fraudulently Obtaining Controlled Substances and Misbranding Drugs

 Department of Justice

U.S. Attorney’s Office
Western District of Pennsylvania

FOR IMMEDIATE RELEASE
Friday, September 17, 2021

South Hills Pharmacist Pleads to Health Care Fraud Conspiracy, Fraudulently Obtaining Controlled Substances and Misbranding Drugs

PITTSBURGH, PA - A South Hills pharmacist pleaded guilty in federal court to charges of obtaining controlled substances by fraud, misbranding of drugs, and health care fraud conspiracy, Acting United States Attorney Stephen R. Kaufman announced today.

Timothy W. Forester, 46, of Venetia, PA pleaded guilty to three counts before Senior United States District Judge David S. Cercone.

In connection with the guilty plea, the court was advised that Forester was a licensed pharmacist who owned four pharmacies – Century Square Pharmacy in West Mifflin, PA and Prescription Center Plus with locations in South Park, PA, McMurray, PA and Eight Four, PA. From on or about November 14, 2018, to on or about February 14, 2019, Forester admitted he knowingly, intentionally and unlawfully obtained oxycodone and hydrocodone, Schedule II controlled substances, by misrepresentations, fraud, and deception. Forester admitted he did not place the controlled substances into the inventories of the four pharmacies and did not maintain records to show the controlled substances were dispensed. In addition, Forester admitted he relabeled generic drugs as name brand medications and then sold them as if they were the more expensive drugs. Finally, Forester admitted filling prescriptions with generic drugs, but billing Medicare and Medicaid for the more expensive name brand drugs, thereby committing health care fraud and causing a loss to Medicare and Medicaid of approximately $680,000.

“Timothy Forester ordered opioids without adding them to inventory, mislabeled generic drugs as name-brand medications, and billed Medicare and Medicaid for name-brand drugs when he provided generics, all in violation of federal law,” said Acting U.S. Attorney Kaufman, “We will continue to pursue medical professionals who engage in fraud schemes to enrich themselves at the expense of their patients.”

“U.S. consumers rely on health care professionals to follow FDA requirements pertaining to prescription medications. When they take actions to evade these requirements, they put patient health at risk,” said Special Agent in Charge Mark S. McCormack, FDA Office of Criminal Investigations Metro Washington Field Office. “We will continue to investigate and bring to justice those who threaten the safety of the nation’s drug supply and, ultimately, the patients who take those drugs.”

“Pharmacy professionals who mishandle opioids in an effort to enrich themselves only exacerbate the challenges and devastation families and communities experience as a result of our nation's opioid epidemic," said Maureen R. Dixon, Special Agent in Charge for the Inspector General’s Office of the U.S. Department of Health and Human Services in Philadelphia. “We will continue to work with our law enforcement partners to bring unscrupulous health professionals to justice.”

“Pharmacists such as Forester have an obligation to properly dispense and safeguard controlled substances such as oxycodone and hydrocodone,” said Thomas Hodnett, Acting Special Agent in Charge of the Drug Enforcement Administration’s (DEA) Philadelphia Field Division. “Forester used his position of trust and access to obtain these powerful painkillers for his own use through fraud and deception.”

Judge Cercone scheduled sentencing for February 8, 2020 at 11:30 a.m. As to Count 1, the law provides for a maximum sentence of four years in prison, a fine of $250,000 or both. As to Count 11, the law provides for a maximum sentence of three years in prison, a fine of $250,000 or both. As to Count 12, the law provides for a maximum sentence of 10 years in prison, a fine of $250,000 or both. Under the Federal Sentencing Guidelines, the actual sentence imposed is based upon the seriousness of the offenses and the prior criminal history, if any, of the defendant.

Assistant United States Attorney Robert S. Cessar is prosecuting this case on behalf of the government.

The investigation leading to the filing of charges in this case was conducted by the Western Pennsylvania Opioid Fraud and Abuse Detection Unit, which combines personnel and resources from the following agencies to combat the growing prescription opioid epidemic: Federal Bureau of Investigation, U.S. Health and Human Services – Office of Inspector General, Drug Enforcement Administration, Internal Revenue Service-Criminal Investigations, Pennsylvania Office of Attorney General - Medicaid Fraud Control Unit, United States Postal Inspection Service, U.S. Attorney’s Office – Criminal Division, Civil Division and Asset Forfeiture Unit, Department of Veterans Affairs-Office of Inspector General, Food and Drug Administration-Office of Criminal Investigations and the Pennsylvania Bureau of Licensing.

Topic(s): 
Prescription Drugs
Health Care Fraud

A federal grand jury today returned a five-count indictment charging a Gloucester County, New Jersey, man with defrauding his employer’s health insurance plan out of more than $4 million by submitting fraudulent claims for medically unnecessary compounded medications, Acting U.S. Attorney Rachael A. Honig announced today.

 Department of Justice

U.S. Attorney’s Office
District of New Jersey

FOR IMMEDIATE RELEASE
Friday, September 17, 2021

Gloucester County Man Charged with Fraud for Role in Healthcare Conspiracy

CAMDEN, N.J. – A federal grand jury today returned a five-count indictment charging a Gloucester County, New Jersey, man with defrauding his employer’s health insurance plan out of more than $4 million by submitting fraudulent claims for medically unnecessary compounded medications, Acting U.S. Attorney Rachael A. Honig announced today. 

Christopher Gualtieri, 48, of Franklinville, New Jersey, is charged with conspiracy to commit health care fraud and mail fraud and individual acts of mail fraud. Gualtieri was also charged with making false statements to federal agents during the investigation, as well as preparing and filling fraudulent oxycodone prescriptions. Gualtieri is scheduled to appear today by videoconference before U.S. Magistrate Judge Sharon A. King. The case is assigned to U.S. District Judge Robert B. Kugler in Camden.

According to the indictment:

Compounded medications are specialty medications mixed by a pharmacist to meet the specific medical needs of an individual patient. Compounded drugs can be properly prescribed when a physician determines that an FDA-approved medication does not meet the health needs of a particular patient, such as if a patient is allergic to a dye or other ingredient.

Gualtieri and others learned that certain compound medication prescriptions – including vitamins, scar creams, pain creams, and sunscreens – were reimbursed by their health insurance plan for up to thousands of dollars for a one-month supply. Gualtieri recruited co-workers who were covered by their employer’s self-funded health insurance plan to agree to receive medically unnecessary compounded medications for themselves and their family members. Gualtieri and others caused the submission of fraudulent prescriptions to compounding pharmacies, which filled the prescriptions and billed the health insurance plan’s pharmacy benefits administrator.  The pharmacy benefits administrator paid the compounding pharmacies more than $4 million for compounded medications arranged by Gualtieri and two conspirators for themselves, their dependents, and other family members. Gualtieri received a portion of the amount paid by the pharmacy benefits administrator to the compounding pharmacies. Gualtieri then paid cash and other remuneration to his conspirators for their participation in the scheme. When questioned by special agents of the FBI, Gualtieri falsely denied recruiting others to receive compounded medications and falsely denied paying cash to others for their participation in the scheme. 

During the same time period as the conspiracy involving compounded medications, Gualtieri also prepared and filled fraudulent prescriptions for oxycodone for himself and a family member. 

Gualtieri faces a maximum penalty on the conspiracy and mail fraud counts of 20 years in prison, a maximum penalty on the false statements count of five years in prison, and a maximum penalty on the obtaining drugs by fraud count of four years in prison. He also faces a fine on each count of up to $250,000 or twice the gross gain or gross loss from the offense, whichever is greatest.  

Acting U.S. Attorney Honig credited agents of the FBI, Philadelphia Field Office, Health Care Fraud Task Force, under the direction of Acting Special Agent in Charge Bradley S. Benavides, and task force members from the Pennsylvania Attorney General’s Office, Department of Health and Human Services – Office of Inspector General, and the Philadelphia Police Department, as well as diversion investigators of the Drug Enforcement Administration, New Jersey Division, Camden Resident Office, under the direction of Special Agent in Charge Susan A. Gibson, with the investigation leading to the indictment. Acting U.S. Attorney Honig also thanked U.S. Postal Service – Office of Inspector General, for their assistance in the investigation.

The government is represented by Assistant U.S. Attorney Jeffrey Bender of the U.S. Attorney’s Office in Camden.

The charges and allegations contained in the indictment are merely accusations, and the defendant is presumed innocent unless and until proven guilty.

Topic(s): 
Health Care Fraud
Component(s): 
Press Release Number: 
21-416