Insurance Fraud NEWS
Alabama pharma sued for suspected cons in glucose test strips
September 19, 2018, Montgomery, AL
A pharmaceutical company is suing a pharmacy network that operates in Alabama for fraudulently billing insurance companies for expensive blood glucose test strips that either weren't shipped or patients received a cheaper brand.
The civil case was filed in the Northern District of Alabama on September 11 by attorneys for the pharmaceutical company Roche Diagnostics Corporation. The case is filed against the Priority Healthcare Network, which operates pharmacies primarily in Alabama and Mississippi.
In the filing, Roche claims Priority Healthcare was billing insurance companies for hundreds of thousands of boxes of glucose test strips. But, the filing states, the pharmacies had only purchased and delivered to customers a fraction of the number they reported.
The Priority Care network "is engaged in a nationwide scheme to carry out insurance fraud related to diabetes care supplies, specifically the test strips used to monitor the level of glucose in the blood," the complaint says. "The Priority Care enterprise bills insurance companies multiple millions of dollars annually for blood-glucose test strips that are either not shipped to patients at all, or are different from--and priced much higher than--the products that patients actually receive."
When pharmacies are audited and insurance, or pharmacy benefit managers, cut off benefits for the pharmacy in question, the filing says Priority Care simply moves customers' prescriptions to other pharmacies in the network.
From January 1, 2013 through the end of the first quarter of 2018, Roche paid more than $37.5 million dollars to insurance companies and their PBMs for these test strips that were either not shipped to patients or were different from those that patients actually received.
The filing states that Priority Healthcare operated several pharmacies in Phenix City, Jasper, Carbon Hill, Pinson, and Vincent. These included Vickers Priority Care Pharmacy, Carbon Hill Express Care Pharmacy, Vincent Priority Care Pharmacy, Jasper Express Care Pharmacy, Bowie's Priority Care Pharmacy, B & K Priority Care Pharmacy, Medical Park Pharmacy.
It's unclear what kind of test strips patients who ordered through these pharmacies actually received.
"Documents obtained by Roche show that some of Priority Care's patients are receiving Roche-branded products that have different product codes (and different prices) than the ones for which Priority Care submitted insurance claims," Roche's complaint states.
"However, Priority Care's fraudulent switching of one Roche product for a different one explains only a small portion of the discrepancy...Priority Care has submitted hundreds of thousands more insurance claims for Roche's retail test strips than the total number of Roche products that Priority Care's records (or Roche's records) document that Priority Care actually purchased. These hundreds of thousands of insurance claims for Roche retail strips are completely unaccounted for."
According to the complaint, the Priority Care network is controlled by Phillip Anthony Minga and Konie Minga. Phillip Minga has previously been convicted of criminal insurance fraud and has been banned by the federal government from providing mail-order diabetes care supplies to Medicare patients, the filing says. His wife Konie Minga's name appears as the owner on the network's pharmacies, but workers say Phillip Minga is personally involved, according to the filing.
U.S. Chief District Judge Karon O Bowdre ordered Monday that Priority Care not purchase or submit any more reimbursements to insurance companies for test strips until the case is adjudicated. Priority Care was also ordered to provide information like what products patients actually received, and how many claims the company made since April, by October 2.
The judge ordered that both parties meet for mediation before October 17.
An attorney for Priority Healthcare declined to comment.