Long-term care pharmacy services company Omnicare and parent CVS Health Corp. said Tuesday that they will “vigorously defend” themselves against a federal civil lawsuit alleging that Omnicare fraudulently billed federal healthcare programs for “hundreds of thousands” of “stale” or invalid prescriptions for residents at more than 3,000 senior living communities.
The government is seeking damages and civil penalties under the False Claims Act.
“We do not believe there is merit to these claims, and we intend to vigorously defend the matter in court,” CVS Health said in a statement to McKnight’s Senior Living. “We are confident that Omnicare’s dispensing practices will be found to be consistent with state requirements and industry-accepted practices.”
The billings to Medicare, Medicaid and Tricare, according to the federal government, were for drugs that included antipsychotic, anticonvulsant and antidepressant medications dispensed to residents of more than 3,000 assisted living communities, group homes, independent living communities and other non-skilled residential long-term care facilities in more than 30 states and Washington, D.C.
Among the operators of the facilities were Atria Senior Living, Brookdale Senior Living, Five Star Senior Living and Sunrise Senior Living. None are named as defendants in the 89-page complaint.
Instead of obtaining new prescriptions from residents’ physicians after the old ones had expired or exhausted their refills, the lawsuit alleges, Omnicare assigned a new number to each old prescription and continued dispensing drugs for months or years after the prescriptions had expired. The practice was followed from 2010 to 2018 until Omnicare and CVS learned of the federal investigation, the government said.
The federal government maintains that the practice put senior living residents at “significant risk of harm” because the expiration of a prescription normally triggers a physician visit to evaluate whether a resident should continue taking a medication.
“In contrast to traditional skilled nursing homes, where residents have access to 24-hour medical care supervised by physicians, assisted living and other residential facilities offer more limited medical care or none at all,” the lawsuit states. “In particular, these facilities generally do not have physicians on staff to oversee and monitor residents’ drug therapy. Rather, residents in these communities typically rely on their own doctors, outside of the facilities, to prescribe drugs, monitor the drugs’ effects, and determine whether they should stop taking a drug or alter the dosage or frequency with which a drug is taken.”
Omincare primarily serves skilled nursing facilities, according to the lawsuit, which also states that “[b]ecause SNF resident care is supervised by physicians, some states permit pharmacies to dispense prescription drugs to SNFs until the physician discontinues the prescription.”
The company’s policy “prohibited pharmacies from dispensing prescription drugs to individuals in residential facilities [such as assisted living communities] more than one year after the prescription was written,” according to the complaint.
Omnicare, however, the lawsuit alleges, offered “little or no training” to employees on “how the requirements for dispensing medications differ between skilled and unskilled facilities” and how to use the company’s computer system properly to differentiate between the two types of settings. “Omnicare pharmacies frequently did not distinguish between assisted living facility residents and skilled nursing facility residents, refilling drugs and allowing prescriptions to ‘roll over’ for residents of any long-term care facility,” according to the complaint.