In a shocking case of healthcare corruption, a New York-based specialty pharmacy has admitted to altering patient medical records and submitting them to Medicare in support of prior authorization requests.
According to the settlement agreement, DJ Drugs & Surgicals Inc. processed and filled prescriptions for proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors, an expensive class of cholesterol-lowering medication. Between June 2017 and October 2018, DJ Drugs often completed and submitted prior authorization requests to insurers in order to obtain insurance coverage for PCSK9 prescriptions.
As part of this settlement, DJ Drugs agreed to a series of factual admissions, including that, on at least 28 occasions and without express authorization from the prescribing physician, it removed certain information in supporting documentation (e.g., laboratory results, patient medical records) associated with PCSK9 prior authorization requests. DJ Drugs also admitted that it then submitted the altered documents to Medicare plan sponsors for approval.
$115,000 will be paid by DJ Drugs to settle this matter. The company has agreed to a series of factual admissions, including the alteration of patient medical records and the submission of altered documents to Medicare.
This case was announced by Rachael S. Rollins, United States Attorney; Phillip M. Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General; and Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division. Assistant U.S. Attorney Charles B. Weinograd of Rollins’ Affirmative Civil Enforcement Unit handled the matter.
The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation.
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Key Facts
- State: Massachusetts
- Category: Drug Trafficking|Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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