Dental Services Fraud

The Medicaid Dental Center (MDC), a corporation in North Carolina that owned a chain of dental clinics under the name of Smile Starters and Carolina Dental Center, has agreed to pay $10,000,050 to the federal government and to the State of North Carolina for Medicaid fraud allegations. MDC is owned by dentist Michael Derose and Letitia Ballance and were discovered to have performed unnecessary pulpotomies (commonly referred to as “baby root canals,” and unnecessarily placed stainless steel crowns in children, in order to submit wrongful claims for Medical Assistance (Medicaid monies). Medicaid financing is shared in all states between the federal and state governments. If you are seeing fraud on the government, contact us by calling 800-377-1812 for strictly confidential advice from experienced counsel, with no fee obligation.

Pharmacist Blows Whistle on CVS - America’s Largest Pharmacy Chain Settles for $37 Million

CVS, America’s largest pharmacy chain, recently agreed to a $36.7 million settlement over charges that they defrauded taxpayers by overcharging Medicaid for prescription drugs. The federal and state investigation of CVS began in 2003 when Bernard Lisitza, an Illinois pharmacist, alerted authorities to CVS’s practice of overcharging Medicaid to fill prescriptions for ranitidine, the generic form of the popular drug Zantac®.

Mr. Lisitza, who will collect over $4.3 Million as his legal reward portion of the settlement, delivered evidence to the government that CVS was fraudulently switching prescriptions from the price-capped and less expensive tablet form of ranitidine to the more expensive capsule form in order to charge the government a higher price.

According to the government complaint, the illegal switch caused the federal government to pay CVS more than four times what it would have paid for the tablets. Capsules and tablets are considered different drugs and state pharmacy laws often prohibit the substitution of capsules for tablets. Because ranitidine capsules are so rarely prescribed, the federal government had not set a price ceiling as they had for tablets.

The case alleged that in switching the prescriptions, CVS had violated federal and state False Claims Acts which prohibit submitting fraudulent claims to the federal government. Companies that violate the False Claims Act may be found liable for damages up to three times the amount of the fraud, and $5,500 to $11,000 per false claim. The False Claims Act allows the whistleblower, known as the “relator,” to awards of 15%-20% of the government’s recovery in a settlement or lawsuit.

Pharmacists like Mr. Lisitza are in a unique position to uncover fraud and have played a critical role in helping state and federal governments recover tens of millions of dollars in false and fraudulent charges.

If you are seeing fraud on the government, contact us by calling 800.377.1812 for strictly confidential advice from experienced counsel, with no fee obligation.