Pharmacist and Two Pharmacies Agree to $1 Million False Claims Act Settlement - Policy & Medicine
On December 8, 2021, Riad Zahr, a Michigan pharmacist, along with two specialty owned pharmacies formerly owned and operated by Zahr, reached a $1 million settlement with the United States Department of Justice over allegations that they submitted false claims for the drug Evzio. Evzio was an injectable naloxone hydrochloride used to reverse opioid overdoses and was the highest-priced version of naloxone on the market. Insurers often required prior authorization requests before they would approve coverage for Evzio.
The United States alleges that between August 1, 2017 and June 30, 2019, Plymouth Towne Care Pharmacy d/b/a People’s Drug Store and Shaska Pharmacy LLC d/b/a Ray’s Drugs submitted false claims for Evzio to Medicare. The two pharmacies allegedly submitted false and misleading prior authorization requests for Evzio that included clinical assertions for which the pharmacies lacked factual basis.
The government further alleged that there were times where Zahr and the pharmacies initiated Evzio prescriptions based on information received from kaléo Inc. (the manufacturer of Evzio), such as bare-bones patient lists with only basic biographical details. Zahr and the pharmacies also allegedly included assertions in the prior authorization requests for Evzio that were purportedly written by prescribing physicians, regarding the comparative effectiveness of Evzio, but were really written by the pharmacies or Zahr. The prescribing physicians did not review, sign, or...
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