May 2, 2022. The United States Department of Justice and numerous States announced a False Claims Act settlement with online retail pharmacy PillPack LLC, a wholly owned subsidiary of Amazon.com, Inc. Under the settlement, the pharmacy paid over $5.7 million to the Government for losses to the Medicare and Medicaid Programs resulting from alleged false claims for insulin. Former Senior DOJ Prosecutors at Tycko & Zavareei LLP, Renée Brooker and Eva Gunasekera, represented the whistleblowers, who received 21 percent of the settlement amount for reporting the allegations to the Government.
Prosecutors with the U.S. Attorney’s Office for the Southern District of New York (Manhattan) are commended for their outstanding investigation and favorable resolution of this case, led by Deputy Chief Pierre Armand and Assistant United States Attorney Danielle Levine. Their exhaustive work on the case led to the restoration of these funds to the Medicare and Medicaid programs.
“Every year we are required to complete Federal training called ‘Fraud, Waste and Abuse.’ As healthcare providers, it was our responsibility to report. We were lucky to find such an amazing team of litigators who believed from the start we could make a difference,” said the two pharmacist whistleblowers.
In 2019, the pharmacists reported to the Government that PillPack was submitting false claims to Medicare and Medicaid for insulin pens. PillPack uses software to manage, dispense and bill Medicare and Medicaid for insulin, including a technology called the Refill Logic. The Refill Logic determines refill due dates for medications such as insulin. The Refill Logic program was supposed to prevent PillPack pharmacists from prematurely dispensing refills to patients and ensure that Medicare and Medicaid were not billed for more insulin than the doctor prescribed, or the patients needed. However, the Refill Logic program generated premature refill due dates, causing PillPack pharmacists to dispense insulin pen refills to patients days or weeks before the patients needed them according to what their doctors prescribed.
PillPack admitted to these allegations in the settlement agreement.
Over 30 million people are living with diabetes in the United States and over half of those people receive coverage for their insulin from the Medicare and Medicaid programs. Senators Chuck Grassley and Ron Wyden cautioned about the financial toll insulin costs are placing on the Medicare and Medicaid programs: “As the committee charged with oversight of Medicare and Medicaid, we are concerned about the impact of rising insulin costs on patients and taxpayers.”
Exploiting this need for insulin, PillPack caused the Medicare and Medicaid programs to pay more than they should have paid for unprescribed and unusable insulin.
The Justice Department needs whistleblowers to help them catch pharmacy fraudsters and protect the Medicare and Medicaid programs. If you would like to report healthcare fraud, you can contact the attorneys at Tycko & Zavareei LLP who represented the pharmacist whistleblowers. Eva Gunasekera and Renée Brooker are former officials of the United States Department of Justice and prosecuted whistleblower cases under the False Claims Act. Eva was the Senior Counsel for Health Care Fraud. Renée served as Assistant Director at the United States Department of Justice, the office that supervises False Claims Act cases in all 94 United States District Courts. Eva and Renee now represent whistleblowers. For a free consultation, you can contact Renée at [email protected] (tel.: 202-417-3664) or contact Eva Gunasekera at [email protected]. You can also go to Tycko & Zavareei LLP’s website for whistleblowers to learn more at https://www.fraudfighters.net/.