Behn & Wyetzner, Chartered

Representing Qui Tam whistleblowers

  • Chicago’s Behn & Wyetzner
  • Whistleblower Attorneys | Chicago, IL | Behn Wyetzner, Chartered
  • Qui Tam Whistleblower Compensation Awards | Behn Wyetzner, Chartered
  • Our Clients
  • FAQs for Whistleblowers
  • History of the Federal False Claims Act
  • Retaining Chicago’s Behn & Wyetzner
Home / Blog Health Care Fraud / How a Pharmacist Becomes A Qui Tam Whistleblower

How a Pharmacist Becomes A Qui Tam Whistleblower

June 29, 2015

Pharmacists as Qui Tam Whistleblowers | Behn & WyetznerAs front-line professionals responsible for dispensing medications to Medicaid beneficiaries, pharmacists are particularly well positioned to discover and report Medicaid fraud. As a result, pharmacists have initiated a number of highly successful qui tam actions under the False Claims Act. Time after time, successful qui tam whistleblower actions by pharmacist relators have successfully recovered taxpayer funds.

For example, in a Medicaid fraud case against Walgreens, the pharmacist became a qui tam relator after discovering the drug switching in processing transfers of prescriptions from Walgreens pharmacies. According to his qui tam Complaint, the pharmacist discovered the Medicaid fraud after noting that a Walgreens prescription was for ranitidine capsules rather than tablets, the industry standard. The pharmacist relator stated that Walgreens pharmacists told him that the pharmacy chain had set up its system to fill all ranitidine prescriptions as capsules regardless of what a physician had specifically prescribed.

The same pharmacist relator also successfully pursued a qui tam action against CVS pharmacies for Medicaid fraud arising from drug switching, which resulted in a $37 million settlement.

The initial qui tam case by the relator pharmacist was against his prior employer, Omnicare Inc., the nation’s largest pharmacy for nursing homes. That Medicaid fraud case resulted in a $50 million settlement of False Claims Act allegations.

The Omnicare case was the first to challenge generic drug switching, and served to strengthen Medicaid’s price containment programs for generic drugs. The qui tam relator discovered the conduct which led to this settlement while he was a pharmacist at Omnicare. The pharmacist relator was represented by qui tam attorneys at Behn & Wyetzner, Chartered.

This same pharmacist, after being fired by Omnicare, discovered that similar switching was being done by CVS and Walgreens. Those cases also were investigated and filed on the pharmacist’s behalf by Behn & Wyetzner, Chartered. The CVS case was the first generic drug switching case settlement by a retail pharmacy. CVS paid $37 million to settle claims brought by the United States, 23 states and the District of Columbia.

That pharmacist is also currently pursuing a case against the distributor of the drugs, as he saw the pattern of the switching happening at the various drug stores being caused by the distributor.

The partners of Ven-a-Care of the Florida Keys, a pharmacy, successfully challenged the way in which Medicaid drugs were priced. Ven-a-Care initiated a series of state and federal False Claims Act cases against drug manufacturers for falsely reporting “Average Wholesale Prices” to state Medicaid programs. These cases have recovered hundreds of millions of dollars in taxpayer funds, and ongoing cases stand to recover billions more.

Two veteran pharmacists helped the government recover $84 million through a qui tam action against Merck-Medco Managed Care, L.L.C., a Pharmacy Benefit Manager (“PBM”). This case changed the way in which state and federal governments deal with PBMs. The pharmacists alleged that the PBM had engaged in fraudulent Drug Utilization Reviews, unlawfully cancelled prescriptions, created false records of physician contacts, and used technicians to perform functions that must be done by pharmacists.

Two pharmacists filed separate cases that resulted in a $7 million recovery from Rite Aid under state and federal False Claims Acts. The settlement resolved the pharmacists’ allegations that the company had been:

  • failing to delete or readjudicate prescriptions that had been billed to Medicaid but were never picked up;
  • restocking items without “lot control;” and
  • billing for partially filled prescriptions as if a full prescription had been delivered.

Employees of Interstate Pharmacy Corp./Liliha of Honolulu, Hawaii successfully pursued a Medicaid fraud case that led to a $4 million recovery from the pharmaceutical company, Bergen Brunswig Corp. The employees reported that the company was recycling and reusing pills returned from nursing home facilities in violation of state and federal laws.

A pharmacist’s successful pursuit of a qui tam case requires a high degree of specialized legal expertise. The pharmacist’s qui tam lawyer must be familiar with federal and state False Claims Acts, federal and state Medicaid law and regulations, federal and state Food and Drug Acts, state pharmacist licensure provisions, and state pharmacy regulations. False claims in Pharmacy often involve the intricacies of state pharmacy provider applications and claims procedures, which vary from state to state.

A successful qui tam prosecution also will involve the pharmacist and his qui tam attorney working closely with various state and federal agencies, including the U.S. Department of Justice, U.S. Attorney’s Offices, the Federal Bureau of Investigation, the U.S. Department of Health and Human Services, the U.S. Food and Drug Administration, state Attorneys General offices, state Medicaid Fraud Control Units, state Medicaid agencies, state Boards of Pharmacy, and the National Association of Medicaid Fraud Control Units.

The lawyers at Behn & Wyetzner, Chartered have years of expertise pursuing and settling qui tam cases by pharmacists against pharmacies. They have worked closely with pharmacists, federal and state prosecutors and investigators, and experts, to pursue successful False Claims Act prosecutions and qui tam litigation.

Filed Under: Health Care Fraud, Pharmacy Fraud

Image of Daniel Hergott

Daniel R. Hergott joined Behn & Wyetzner in May 2011, after graduating magna cum laude from Chicago-Kent College of Law. During law school, Mr. Hergott worked as an extern for The Honorable Ann Claire Williams of the U.S. Court of Appeals for the Seventh Circuit and as a clerk at the U.S. Attorney’s Office for the Northern District of Illinois and the Eastern District of Wisconsin. Read more.

Read more articles by Daniel Hergott

Blog Topics

  • General (20)
  • Grant and Education Fraud (1)
  • Health Care Fraud (10)
  • Housing and Mortgage Fraud (2)
  • Interesting Cases (2)
  • Legislative News (2)
  • News (16)
  • Pharmacy Fraud (3)
  • Relator Experiences (1)
  • Relator Issues (1)
  • Securities and Commodities Fraud (5)
  • Tax Frauds (3)
  • Whistleblower Protection (3)

Blog Archives

  • March 2024 (1)
  • October 2021 (2)
  • July 2020 (2)
  • May 2019 (1)
  • April 2019 (1)
  • February 2019 (1)
  • July 2018 (1)
  • November 2017 (1)
  • September 2017 (1)
  • February 2017 (1)
  • January 2017 (2)
  • December 2016 (1)
  • November 2016 (1)
  • July 2016 (1)
  • May 2016 (1)
  • January 2016 (1)
  • December 2015 (1)
  • September 2015 (1)
  • July 2015 (2)
  • June 2015 (3)
  • May 2015 (1)
  • March 2015 (1)
  • February 2015 (1)
  • January 2015 (1)
  • November 2014 (1)
  • January 2014 (1)
Do You Have a Case? How Can We Help? Act Now
10 North Dearborn Street, 6th Floor, Chicago, IL 60602
Phone: 312.629.0000
FAX: 312.629.0000
info@behnwyetzner.com
  • Firm Experience
  • Attorneys
  • Qui Tam Whistleblower Compensation Awards | Behn Wyetzner, Chartered
  • Our Clients
  • Whisleblower FAQs
  • False Claims Act
  • Blog
  • Accessibility
  • Contact Us
Website Design by ePageCity