A Florida-based pharmacy, OHM Pharmacy Services, also known as "Benzer" or "Auburndale," has agreed to plead guilty to health care fraud. As part of this agreement, the pharmacy will pay $82,000 in restitution and $1,018,000 to resolve violations of the False Claims Act.
OHM admitted to its role in a scheme involving the dispensing of Evzio, a product used for opioid overdoses. Due to its high cost, insurance providers often required prior authorization, which OHM falsely completed without proper authorization or based on incorrect information. U.S. Attorney Leah Foley stated, "OHM deliberately falsified prior authorization requests to ensure that Medicare would reimburse its fraudulent claims for Evzio."
Jodi Cohen, Special Agent in Charge of the FBI Boston Division, emphasized the impact of such fraud: "Fraudulent schemes like this one are not only unethical, but illegal, and drive up the cost of health care for all of us."
As part of the resolution, OHM entered into an integrity agreement with the Department of Health & Human Services Office of Inspector General. This agreement mandates new measures to ensure compliance with laws relating to prior authorizations.
The civil settlement concludes claims under the whistleblower provisions of the False Claims Act brought by a former employee of Evzio's manufacturer, kaléo Inc. The whistleblower will receive $285,040 from the civil settlement.
This case is part of ongoing efforts against fraudulent claims involving Evzio. In previous years, the U.S. Attorney’s Office reached settlements with kaléo Inc. and other pharmacies over similar issues.
The recent resolution resulted from collaboration between various government bodies, including the FBI, the Department of Defense Criminal Investigative Service, and other regulatory offices. The case was managed by Assistant U.S. Attorneys Abraham R. George, Mackenzie A. Queenin, and Lauren A. Graber.