CVS subsidiary accused by DOJ of fraudulent billing 

justice
DOJ has filed a False Claims Act suit against CVS subsidiary Omnicare. (Getty/designer491)

The federal government has joined a lawsuit alleging Omnicare, a subsidiary of CVS Health, fraudulently billed Medicare, TRICARE and Medicaid for thousands of drugs. 

The Department of Justice on Tuesday joined the whistleblower suit (PDF) that charges Omnicare dispensed hundreds of thousands of drugs to elderly patients at thousands of long-term care facilities between 2010 and 2018.

Omnicare is the nation’s largest pharmacy provider for such facilities. CVS acquired the company in 2015. 

“Omnicare, and its parent company CVS, allowed Omnicare pharmacies to dispense prescription drugs indefinitely to individuals living in these residential facilities based on prescriptions that had expired, were out of authorized refills, or were otherwise invalid,” DOJ said in the complaint.  

RELATED: Aetna whistleblower accuses CVS of false claims, unsealed lawsuit reveals 

Omnicare ignored prescription refill limits and expiration dates, according to the suit, and instead continued to provide the drugs based on outdated prescriptions. Heeding the expirations would have launched a consult with a patient’s physician, which would review whether the prescription should be renewed, DOJ said. 

In a statement to FierceHealthcare, a spokesman for CVS Health said the healthcare giant is “confident that Omnicare’s dispensing practices will be found to be consistent with state requirements and industry accepted practices.” 

“We do not believe there is merit to these claims, and we intend to vigorously defend the matter in court,” said Mike DeAngelis, senior director of corporate communications.

The DOJ alleges that Omnicare allowed expired prescriptions to roll over for residents in at least 1,766 long-term care facilities. At an additional 1,476 locations, Omnicare used its automated “cycle fill” system to automatically fill these prescriptions, according to the lawsuit. 

RELATED: Omnicare pays $28M to settle Abbott Laboratories kickback scheme allegations 

Omnicare has been investigated before on similar charges, DOJ said, and the company has been the subject of “numerous” federal investigations and lawsuits in the past—a number of which were concluded with substantial settlements. 

For example, in 2012, Omnicare paid a $50 million settlement to DOJ on similar charges that it dispensed drugs on invalid prescriptions. 

Internal audits have also flagged a lack of renewal reviews conducted by physicians as a “recurring issue,” DOJ said. 

“Senior management at Omnicare and CVS knew Omnicare’s pharmacies were routinely dispensing drugs without valid prescriptions,” DOJ said in the complaint. “But they failed to begin to address the problem until they found out Omnicare was being investigated again, this time by this Office.” 

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