2019 Pharmacy Fraud: Issues You Should Know About

Darshan: So let's talk about fraud in the context of pharmacies. Now I'm going to actually do this one slightly differently. I'm going to talk and start from the punchline and then go in deeper. So those of you who really just want to know what are the quick takeaways, you're going to get that in the first minute and a half. But then we're going to talk about exactly why those takeaways matter and what happened. Narrator: This is the DarshanTalks Podcast, regulatory guy, irregular podcast with host Darshan Kulkarni. You can find the show on Twitter @darshantalks or the show's a website at darshantalks.com. Darshan: There have been six major trends in 2019 around pharmacy fraud, and that means that you as a pharmacist need to be aware of these issues. You as a pharmacist need to be taking the appropriate steps so that you are not being caught up in these problems. So the six major issues. Number one, compounding pharmacies are being targeted especially in Florida. Number two, there's an uptick in opioid review. Number three, kickback reviews are being consistently reviewed, shall we say, especially in the context of telehealth. So if you are using telehealth as a pharmacy and that may actually become a problem in the context of kickbacks. That's not to say that telehealth is inappropriate, that's not to say that without it you wouldn't have a kickback problem. But that combination seems to be grabbing people's attention. Darshan: The idea of in manufacturing and compounding, this is the course of care. That's what I was being told. This is okay to do as a pharmacist because just this is what people taught me. That argument is not being accepted anymore. So if you are a pharmacist and you've always gone, "You know what, this is what I was taught. This is okay." Yeah, that's not going to fly anymore. In New York, larger pharmacies are being targeted, and I'd say overall, and this has been happening for several years, if you are a pharmacy using a marketing company, be very, very careful and be sure to audit them. Because marketing companies have the goal of marketing and they will do whatever they can to optimize their sales. Darshan: The problem is that you are left holding the bag and these marketing companies are being sued independently, but you as a pharmacist are being sued and are potentially paying millions of dollars in fines as well. So that's my takeaway. It took me about two and a half minutes to give you that. So if you want to walk away at this time, shut off this podcast, that's fine. But if you want to know why I said what I said, stay tuned. So let's start with the compounding kickbacks. Darshan: The first one I would talk about is in the context of Alabama, those Global Compounding Pharmacy, there were 10 defendants being charged in 103 count indictment, including a nurse practitioner, the owners, a pharmacist, managers, sales representatives and billers. Global describe itself as one of the three largest compounding pharmacies in the US and it primarily shipped compounded drugs from its Haleyville facility, but they did most of that prescription processing, billing and customer service in its call center in Clearwater, Florida. The company hired sales reps who were located in various States and were responsible for generating prescriptions from physicians and other prescribers. Darshan: The company also worked with affiliate pharmacies. The indictment charges essentially said that they were fraudulent in billing healthcare insurers and prescription drug administrators for over $200 million in prescription drugs. In one instance, the defendants' fraudulent conduct caused a prescription plan administrator to pay over $29,000 for one tube of a cream advertised as treating general wounds. Aspects of the scheme included paying prescribers to issue prescriptions. So number one, from a fraud perspective,