A company that handled billing for a Georgia pharmacy will pay $6.5 million to settle allegations it violated the False Claims Act by waiving copays, charging government payers higher prices than permitted and trading federal healthcare business with other pharmacies, the Justice Department said Oct. 12.
The Justice Department alleges that Rome, Ga.-based DermaTran Health Solutions and Pharmacy Insurance Administrators, a separate company that handled billing for DermaTran, skirted federal billing regulations for compound pain creams.
In a news release, the Justice Department called compound pain creams "very lucrative," with TriCare and the Federal Employee Health Benefits Program reimbursing pharmacies hundreds of dollars for these medications. Government insurers would only reimburse pharmacies up to the cost charged to an uninsured patient.
The Justice Department alleges that DermaTran found ways around these regulations, creating unapproved copay waiver programs and charging government insurers upwards of $600 for the creams, while selling the drug to uninsured patients for $30.
After audits discovered the pharmacy's practices, it was dropped from networks. The Justice Department alleges DermaTran then sold its out-of-network prescriptions to other pharmacies who could provide them to patients in-network, constituting an illegal kickback.
These pharmacies, in Texas and Alabama, will also contribute to the total $6.8 million settlement.
The claims resolved by the settlement are allegations, and the pharmacies have not admitted liability.