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Specialty Pharmacy Pays $17 Million To Settle Whistleblower Lawsuit Alleging Medicare Billing Fraud

February 4, 2019

Kessler Topaz Meltzer & Check, LLP ("Kessler Topaz") announced today that Pentec Health Inc. ("Pentec"), a nationwide specialty pharmacy, has agreed to settle a whistleblower lawsuit and pay the United States government $17 million.  Kessler Topaz represented the whistleblower, Jean Brasher, and filed the qui tam lawsuit in 2013.

The settlement resolves allegations that Pentec induced prescriptions and use of Proplete, an expensive drug compounded and sold by Pentec, by illegally waiving amounts owed by Medicare beneficiaries.  In addition, Pentec was alleged to have overbilled Medicare for excess drug ingredients.

"We believe that this case reaffirms the role that whistleblowers can play in combatting fraud.  Compounding pharmacies cannot promote expensive drugs through illegal means or overbill Medicare for excess ingredients, as this complaint alleges," said David Bocian, a former federal prosecutor and head of Kessler Topaz's Whistleblower and False Claims Act Litigation practice group.  Bocian thanked the U.S. Attorney's Office in Philadelphia for their outstanding work on and dedication to the case.

Pentec was alleged to have routinely waived patient cost-sharing balances under Medicare's prescription drug benefit (Part D) in order to entice Medicare beneficiaries to use Proplete in connection with dialysis treatment, even though, as stated in the Complaint, Proplete was often substantially more expensive than drugs offered by Pentec's competitors.  The Complaint further alleged that Pentec overbilled the government by submitting claims for reimbursement for excess drug ingredients that were used in the compounding process.

The qui tam suit was filed under the False Claims Act, which encourages private citizens to fight fraud against the government by bringing a whistleblower lawsuit.  If the government joins the lawsuit, the whistleblower may receive a monetary reward of between 15 and 25 percent of the recovery.

Kessler Topaz specializes in the prosecution of complex litigation on a contingent basis, litigating matters against the largest multi-national corporations and the most sophisticated defense firms.  Since the Firm's founding it has recovered billions of dollars for its clients, developed a worldwide reputation for success, and repeatedly been named as one of the nation's most prominent plaintiffs firms.

Kessler Topaz's Whistleblower and False Claims Act Litigation practice group includes former federal and state prosecutors with extensive experience litigating health care, securities, corporate and government contract fraud.   The practice group is headed by Kessler Topaz partner David Bocian, a former federal prosecutor, who spent more than ten years in the U.S. Attorney's Office for the District of New Jersey.

David A. Bocian, Esquire
Kessler Topaz Meltzer & Check, LLP
(484) 270-1418
(610) 667-7706

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