A Florida-based pharmacy, known as OHM Pharmacy Services, also referred to as "Benzer" or "Auburndale," has admitted guilt for committing health care fraud. As part of the settlement, OHM will pay restitution amounting to $82,000 and an additional $1,018,000 to resolve violations of the False Claims Act.
OHM admitted to wrongfully dispensing Evzio, a product used in opioid overdose cases, and manipulating insurance claims to secure reimbursement. The pharmacy submitted prior authorization requests under physicians' names without their consent, presenting misleading information to Medicare Part D plans and other insurers. An example given is OHM personnel submitting forms that falsely claimed patients had unsuccessfully used naloxone alternatives.
U.S. Attorney Leah Foley commented, "OHM deliberately falsified prior authorization requests to ensure that Medicare would reimburse its fraudulent claims for Evzio. 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. We will aggressively pursue any attempts to defraud Medicare of taxpayer funds."
Jodi Cohen, Special Agent in Charge of the FBI's Boston Division, stated, "OHM Pharmacy Services admitted today to abusing its dispensing privileges and fleecing taxpayer-funded health care programs in the process. Fraudulent schemes like this one are not only unethical, but illegal, and drive up the cost of health care for all of us. Anyone who engages in criminal conduct to maximize profits should know the FBI and our partners will identify you and ensure that you're held accountable."
Additionally, OHM signed an integrity agreement with the U.S. Department of Health & Human Services Office of Inspector General, mandating compliance with applicable laws for pharmaceutical claims, particularly regarding prior authorizations.
The civil settlement finalizes claims under the False Claims Act provisions brought by a former kaléo Inc. employee, Evzio’s manufacturer. As part of this agreement, the whistleblower involved will receive $285,040 from the settlement.
Previous settlements related to false Evzio claims include a $12.7 million resolution with kaléo Inc. in 2021 and a $1 million settlement with other pharmacies. In 2022, the U.S. Attorney’s Office reached a $1.31 million deferred prosecution agreement and civil settlement with another pharmacy.
The settlement was the result of a collaborative investigation by multiple government offices, including the U.S. Attorney’s Office, the Federal Bureau of Investigations, and several Offices of Inspector General.
The case was managed by Assistant U.S. Attorneys Abraham R. George, Mackenzie A. Queenin, and Lauren A. Graber.
