A Nashville pharmacy company specializing in dispensing drugs to treat HIV and AIDS and its majority owner agreed to pay the U.S. and Tennessee governments up to $7.8 million to settle a whistleblower’s allegations that it defrauded Medicare and TennCare, Tennessee’s Medicaid program.
Marsha McCullough, a former order entry technician for Nashville Pharmacy Services LLC, sued the company under the qui tam or “whistleblower” provisions of the False Claims Act and majority owner Kevin Hartman, alleging they fraudulently billed Medicare and TennCare for drugs in a number of ways.
According to the U.S. Attorney’s Office for the Middle District of Tennessee, the defendants automatically refilled prescriptions without proper authorization required by TennCare; routinely and illegally waived TennCare and Medicare co-payments without an individualized assessment of those beneficiaries’ inability to pay; used pharmaceutical manufacturers’ co-payment cards to pay the co-payments of certain Medicare recipients; billed Medicare and TennCare for certain medications that were dispensed after the beneficiaries had died; and billed both programs for medications that lacked a valid prescription from a licensed provider.
The U.S. Attorney’s Office alleged that Nashville Pharmacy Services engaged in these fraudulent activities from February 2011 through May 2012.
“Pursuing individuals and corporations who engage in health care fraud remains a top priority of the U.S. Attorney’s Office,” said U.S. Attorney David Rivera. “We remain committed to working with our state and federal partners to hold those accountable who attempt to profit at the expense of taxpayers and compromise the integrity of our health care programs.”
Nashville Pharmacy Services has already paid $500,000 to the government and will make additional payments over the next five years. According to the settlement terms, the amount of the payments will be contingent on Nashville Pharmacy Services’ revenue for each year during the five-year period and could ultimately amount to $7.8 million.
Ms. McCullough could receive up to $1.4 million as her award for helping the U.S. and Tennessee recover the health care funds, U.S. Attorney David Rivera said in a statement.