A Florida-based pharmacy has agreed to plead guilty to a federal charge of health care fraud and will pay more than $1 million to resolve criminal and civil allegations tied to false insurance claims for a high-priced opioid reversal drug, authorities announced Thursday.
OHM Pharmacy Services—also known as “Benzer” and “Auburndale”—will pay $82,000 in restitution and an additional $1,018,000 to settle civil violations under the False Claims Act, according to the U.S. Attorney’s Office for the District of Massachusetts.
At the heart of the case is Evzio, a naloxone product used to rapidly reverse opioid overdoses. Because of its steep price, insurers including Medicare Part D plans typically require prior authorization from licensed providers before approving coverage.
Federal prosecutors say OHM staff routinely falsified these prior authorization requests, submitting forms that impersonated physicians or included fake clinical details to secure reimbursement. In many instances, the forms falsely claimed that patients had unsuccessfully tried other naloxone products, such as Narcan, in order to justify Evzio prescriptions.
“OHM deliberately falsified prior authorization requests to ensure that Medicare would reimburse its fraudulent claims for Evzio,” said U.S. Attorney Leah Foley. “It took advantage of the need for naloxone products to combat the opioid crisis by making up information on insurance forms that it knew would be necessary to support reimbursement.”
The case adds to growing concerns over the exploitation of the opioid crisis for profit, even in the realm of life-saving medications.
