Remedi SeniorCare Holding Corporation (Remedi), headquartered in Towson, Maryland, has agreed to pay over $5.3 million to the United States to resolve allegations that it violated the False Claims Act (FCA) by billing the Medicare and Medicaid programs for prescription drugs despite lacking valid prescriptions. The settlement is based on Remedi’s ability to pay and will be paid over time.
The United States alleged that, from Jan. 1, 2015 through March 31, 2021, Remedi submitted false claims to the Medicare and Medicaid programs for prescription drugs that lacked valid prescriptions and were dispensed to residents of assisted living facilities in various states.
“When pharmacies dispense drugs with valid prescriptions, they undermine both patient safety and the integrity of vital federal healthcare programs,” said Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “Today’s resolution demonstrates the Department’s commitment to protecting vulnerable populations and holding accountable pharmacies that fail to comply with their obligations under the False Claims Act.”
“Billing Medicare and Medicaid for prescription drugs without a valid prescription is unlawful and can present serious risks,” said U.S. Attorney Dominick S. Gerace II for the Southern District of Ohio. “As evidenced by this settlement, my Office will enforce the FCA to hold responsible those who improperly bill federal programs.”
“Billing Medicare and Medicaid for drugs dispensed without valid prescriptions puts residents of assisted living facilities at risk and undermines essential safeguards designed to protect patient health and federal health care programs,” said Acting Deputy Inspector General for Investigations Miranda L. Bennett of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS OIG, working closely with our law enforcement partners, will continue to hold accountable those who disregard requirements meant to ensure the safety of patients and the integrity of taxpayer funded programs.”
The settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Maureen Gearhart and Laura Griffieth, former employees of Remedi. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States ex rel. Gearhart & Griffieth v. Remedi SeniorCare Holding Corp., et al., No. 1:20cv970 (S.D. Ohio). The settlement provides for the whistleblowers to receive a share of the settlement payments made over time.
The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Southern District of Ohio, with assistance from HHS-OIG and the Attorney General’s Office for the State of Ohio.
The matter was handled by Fraud Section Senior Litigation Counsel Laurie A. Oberembt of the Justice Department’s Civil Division and Assistant U.S. Attorney Brandi Stewart for the Southern District of Ohio.
The investigation and resolution of this matter illustrate the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
This year the Administration launched the Task Force to Eliminate Fraud and the National Fraud Enforcement Division to enhance the Administration’s war on fraud, waste, and abuse in federal programs. When unscrupulous actors exploit these programs for their own financial gain, they defraud the government, harm the people these programs are designed to aid and protect, and undermine American businesses that play by the rules. The Civil Division’s FCA enforcement plays a critical role in combatting such fraudulent schemes, recovering billions of dollars for the American taxpayers, and holding wrongdoers accountable. FCA matters will continue to be on the forefront of the battle against fraud, and the Civil Division’s FCA work will support and advance the mission of the Task Force to Eliminate Fraud and the National Fraud Enforcement Division.
The claims resolved by the settlement are allegations only and there has been no determination of liability.