PHILADELPHIA – More than three dozen defendants - including local doctors, pharmacists and other medical entities - are the targets of a recently filed fraud lawsuit in Philadelphia alleging they prescribed $4.7 million worth of ineffective pain medication creams to injured workers.
Bringing the lawsuit, filed Sept. 14 in the Philadelphia County Court of Common Pleas, was Liberty Mutual Insurance Company of Boston, which claims the doctors named in the litigation referred patients with Workers' Compensation injuries to pharmacies in which they possessed financial interest and wrote prescriptions for fraudulent pain medication creams.
From there, the pharmacies would allegedly invoice insurance companies, such as Liberty Mutual, for large quantities of those creams – at “highly inflated” prices of up to $8,000 per bottle – while the doctors received illegal kickbacks from the pharmacy defendants, the lawsuit states.
Furthermore, Liberty Mutual alleges the pain medication creams were manufactured in batches through the use of pre-determined formulas, rather than customized for use by individual patients, a clear violation of Food and Drug Administration (FDA) regulations.
According to The Philadelphia Inquirer, an Allentown physician, Dr. Rishin Patel, was the top-billing doctor. Patel billed Liberty Mutual to the tune of $506,163 for pain medication creams distributed by 700 Pharmacy, of which he owns a 12.25 percent financial stake.
One of Patel’s prescription claims totaled $14,447, with Liberty Mutual paying $12,596 of that cost.
Two other doctors with an equal percentage share of 700 Pharmacy as Patel, Dr. Miteswar Purewal and Dr. Shailen Jalali, each billed Liberty Mutual $312,996 and $121,657, respectively. Per the Inquirer, Patel, Purewal and Jalali co-founded a Conshohocken-based consulting group that operates local pharmacies named Insight Medical Partners.
Jeff Jubelirer, a representative for Insight Medical Partners, stated: "Due to the current litigation, however, we are not going to comment at this time."
Furthermore, a minimum of six defendants named in the lawsuit are connected to Workers First, a pharmacy with a majority ownership possessed by three partners of Pond Lehocky Stern Giordano, a Philadelphia-based law firm prominent in the area of Workers' Compensation litigation.
Workers First and Pond Lehocky Stern Giordano are not named as defendants in the litigation, but neither entity returned requests for comment to the Pennsylvania Record.
Liberty Mutual has initiated a motion to file an amended complaint as of Oct. 6, but the case’s docket also reflects the defendants have not yet filed an answer to the lawsuit in state court.
Meanwhile, earlier this year, state Rep. Ryan Mackenzie, R-Berks, introduced House Bill No. 18 for consideration. It would seek to establish a Workers' Compensation drug formulary to “select a nationally recognized, evidence-based prescription drug formulary appropriate for resolving issues related to drugs prescribed for or related to the treatment of work-related injuries, including, but not limited to, the type, dosage and duration of prescriptions.”
The bill was authored with the intent of getting Workers' Compensation patients off their medication back to work as soon as possible, helping to curb opioid drug addiction in the process.
Opponents of the bill targeted it through a negative advertising campaign and have been harshly critical of the legislation, believing it would create a new legal obstacle between employees injured at work and their physicians.
A procedure motion from state Rep. Gene DiGirolamo, R-Bucks, recently sent House Bill No. 18 to the House of Representative’s Rules Committee, where the measure remains pending.
For counts of common law fraud, insurance fraud, worker’s compensation insurance fraud, statutory prohibition of self-referrals and unjust enrichment in the instant lawsuit, the plaintiffs are seeking damages, jointly and severally, in excess of $50,000, for compensatory, consequential, punitive and treble damages, attorney’s fees, litigation expenses, interest, costs, and any other relief the Court finds just and equitable and warranted by applicable law.
The plaintiffs are represented by Alfonso H. Ibrahim of Styliades Mezzanotte & Hasson, in Philadelphia.
Defendants Empire Pharmacy Services LLC, Omni Pharmacy Services LLC, Armour Pharmaceutical Solutions LLC, United Pharmacy Services LLC, Insight Pharmaceutical Solutions LLC and 700 Pharmacy LLC are represented by Daniel J. Siegel in Havertown; defendants MedArbor, LLC, Miroslav Kesic and 1st Choice Pharmacy, LLC are represented by Jill A. Guldin of Fisher Broyles in Philadelphia and defendant Gerald E. Dworkin is represented by Beth L. Weisser and George J. Krueger of Fox Rothschild, also in Philadelphia.
Philadelphia County Court of Common Pleas case 170901541
From the Pennsylvania Record: Reach Courts Reporter Nicholas Malfitano at nickpennrecord@gmail.com