CVS to Pay $3.5 Million to Resolve Allegations that Pharmacists Filled Fake Prescriptions
For Immediate Release
U.S. Attorney's Office, District of Massachusetts
BOSTON – In one of the largest settlements to date involving federal allegations of prescription drug diversion in Massachusetts, CVS Pharmacy, Inc., has agreed to pay $3.5 million to resolve allegations that 50 of its stores violated the Controlled Substances Act by filling forged prescriptions for controlled substances – mostly addictive painkillers – more than 500 times between 2011 and 2014. In addition, CVS has entered into a three-year compliance agreement with the Drug Enforcement Administration (DEA) that requires CVS to maintain and enhance programs it has developed in recent years for detecting and preventing diversion of controlled substances.
“Pharmacies have a legal responsibility to ensure that controlled substances are dispensed only pursuant to valid prescriptions,” said United States Attorney Carmen M. Ortiz. “When pharmacies ignore red flags that a prescription is fraudulent, they miss a critical opportunity to prevent prescription drugs from entering the stream of illegal opiates on the black market. Diverted painkillers are contributing to the devastating opioid epidemic in our Commonwealth. Although CVS is currently undertaking corrective steps to curb the tide of diversion, this settlement pushes CVS to go further and holds the company accountable for its past conduct.”
“DEA registrants like CVS have a corresponding responsibility to dispense controlled substances in accordance with the Controlled Substance Act. When pharmacies fail to adhere to these responsibilities, it allows for the diversion of prescription pain medication, which contributes to the widespread abuse of opiates, is the gateway to heroin addiction, and is devastating our communities,” said DEA Special Agent in Charge Michael J. Ferguson. “Our obligation is to improve public safety and public health, and we are committed to working with our law enforcement and regulatory partners to ensure that these rules and regulations are followed.”
This settlement resolves two investigations of CVS stores initiated by the DEA after it received an increased number of calls reporting forged oxycodone prescriptions. In the first investigation, the DEA identified forged prescriptions filled 403 times at 40 CVS stores in Massachusetts and New Hampshire. In the second investigation, the DEA identified 120 forged prescriptions filled at 10 CVS stores in and around Boston. The DEA estimated the street value of the diverted pills to be over $1 million.
The forged prescriptions traced back to just a few individuals. One of the forgers, P.R., signed a dentist’s name on 56 of 59 oxycodone prescriptions that P.R. was then able to get filled at five CVS locations. CVS pharmacists filled these prescriptions even though CVS banned P.R. in 2011 and its computer system contained notes warning that P.R. had tried to fill forged prescriptions in the past. P.R. managed to circumvent the ban by opening a new patient profile using her own Arizona driver’s license number but with a different last name. The government alleged that CVS should have known that the new profile was really P.R.’s, and that the quantities and frequency of P.R.’s oxycodone prescriptions were excessive, especially coming from a dentist. Moreover, the government alleged, even if CVS had believed the prescriptions to be real, there were red flags that P.R. was “doctor shopping,” including the fact that P.R. presented oxycodone prescriptions from two different providers during a single week at one CVS store.
Another forger, E.M., signed a dentist’s name on 131 prescriptions for hydrocodone – another highly addictive opioid – and then had them filled at eight CVS stores. One of those stores, in South Dennis, Mass., filled 29 forged prescriptions for E.M. in just six months. Those 29 prescriptions totaled 1,290 pills of hydrocodone, or seven pills a day. At a different CVS store, E.M. was able to fill 28 prescriptions that she had forged for herself and three other alleged patients even though the prescriptions were identical except for the patient name and even though E.M. presented some of the prescriptions just days apart. CVS also filled 107 prescriptions that bore the dentist’s Massachusetts address, even though, by then, the dentist had closed her Massachusetts practice and moved to Maine. CVS pharmacists could have discovered that the address on these prescriptions was no longer valid had they called the phone number on the prescriptions or checked the DEA’s website.
Yet another forger, E.D., was able to fill fake prescriptions for hydrocodone and methadone over 200 times at CVS stores. CVS filled the prescriptions, on which E.D. had forged the name of an emergency room physician who according to the prescriptions worked at Brigham & Women’s Hospital in Boston, even though: (a) the physician did not work at Brigham & Women’s Hospital; (b) the prescriptions were issued more often and for larger pill quantities than is normal for prescriptions issued by an ER physician; and (c) 21 of the prescriptions, which were presented and picked up by E.D., a man, purported to be for female patients (and all were filled by the same CVS pharmacy).
Under DEA regulations, pharmacists dispensing the drugs have a responsibility to ensure that he/she is filling only valid prescriptions written for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice. Fulfilling this responsibility requires identifying and resolving red flags that, individually or collectively, indicate that a prescription may be forged or otherwise invalid.
This case was brought as part of the federal response to New England’s opioid crisis. Prescription opioids are habit-forming drugs that lead to the use of other addictive drugs such a heroin. Overdoses from both prescription drugs and heroin have climbed substantially in recent years.
U.S. Attorney Ortiz and DEA SAC Ferguson made the announcement today. The case was handled by Assistant U.S. Attorneys Giselle J. Joffre and Deana K. El-Mallawany of Ortiz’s Civil Division.
Updated June 30, 2016
Health Care Fraud