Recently, a court in the Central District of California unsealed a qui tam complaint against several specialty pharmacies and their private equity fund owners. See United States ex rel. Webster v. BioMatrix Holdings, LLC, 2:18-cv-09333-PSG-PLA (C.D. Cal. Oct. 31, 2018). Relator, a former Vice President for Managed Care at BioMatrix Specialty Pharmacy, alleged that the specialty pharmacy defendants (collectively “BioMatrix”), with the knowledge of their private equity owners, employed a kickback scheme to increase the number and value of prescriptions for hemophilia medications filled through their pharmacies.
Relator alleged that BioMatrix, through a related entity, Pacific Health Group (“PHG”), hired individuals with hemophilia as Regional Care Coordinators (“RCCs”). PHG supposedly created the RCC position to recruit patients with hemophilia to use BioMatrix’s specialty pharmacy services. PHG paid RCCs $150,000 to $300,000 annually, with compensation allegedly tied to the number of patients each RCC referred back to BioMatrix and the amount of hemophilia factor each referred patient filled through BioMatrix. BioMatrix also paid RCCs to attend meetings of hemophilia patient organizations as a way to solicit new patients to switch to BioMatrix pharmacies. In addition, RCCs received commercial health insurance with coverage for hemophilia medications that could be filled through BioMatrix pharmacies. Finally, relator alleged that RCCs were terminated if they did not generate...
Welcome to Reality Check, NewsGuard’s nonpartisan newsletter that tracks the false claims and conspiracy theories that shape our world — and who’s behind them. Please support us by becoming a premi...