Omnicare Medicaid Fraud Settlement | Behn & Wyetzner, Chartered

Recovery Amount: $49.5 Million

Qui Tam Action Alleging Drug Switching Against Omnicare

Pharmacies must provide the drug your doctor prescribes in the form prescribed. If a pharmacy receives a prescription for a tablet, it must dispense a tablet – not a capsule.

Omnicare, Inc., which calls itself, “the nation’s leading provider of pharmaceutical care for the elderly,” paid $49.5 million in November 2006 to settle Medicaid fraud charges that it illegally switched the drugs of senior citizens in nursing homes and other facilities to evade Medicaid price ceilings.

The Qui Tam Fraud

Drugs come in various dosage strengths and forms, such as tablets, capsules, syrups, and suspensions. Under federal and state law, each dosage form or strength is a different drug, even though it might have the same active ingredient. Different dosage forms have different inactive ingredients, and have additional distinctions concerning potential effectiveness and safety concerns that are significant to physicians, patients, and the United States Food and Drug Administration (“FDA”). Different dosage forms and strengths – as different drugs – can also have very different reimbursement rates under the Medicaid program.

The complaint alleges that Omnicare sought to illegally switch the dosage forms of popular generic drugs to increase its government reimbursement under the Medicaid program. The charges primarily involved generic forms of Zantac® and Prozac®. Through this switching scheme, defendants knowingly caused the unlawful submission of false and fraudulent claims and statements to the government.

The case was brought by pharmacist-whistleblower Bernard Lisitza, who had been fired by Omnicare after reporting improper practices. Qui tam lawyers Michael I. Behn and Linda Wyetzner of Behn & Wyetzner, Chartered, in Chicago, represented Mr. Lisitza.

The Omnicare Switching Case

Recovery Amount: $49.5 Million

Qui Tam Action Alleging Drug Switching Against Omnicare

The Qui Tam Fraud

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