Drugs purchased from foreign countries cost significantly more than domestic versions

by: Julia Kyles, CPC Aug 10, 2017

It may look like a great plan at first:

Purchase drugs from a foreign distributor at a lower price than you'd pay for it in the U.S.
Bill Medicare for the drugs as you normally would.
Enjoy the increased profits.

After all it's the same drug, right?

Wrong. Drugs purchased from foreign suppliers are not FDA-approved and practices caught administering and billing for them will face false claims allegations. Case in point - for the second month in a row a pain practice is paying to settle allegations that include billing for foreign drugs.

This time, it's Atlanta-based Atlanta Medical Clinic (AMC) that landed in the government's crosshairs. AMC and the doctor who owns the practice will pay $250,000 to resolve two allegations, the U.S. Attorney for Northern Georgia announced Aug. 2. The practice and owner were accused of administering and billing Medicare for Orthovisc purchased from Canada, as well as billing for the services of an excluded doctor under another doctor's name and national provider identifier. The press release for the settlement agreement does not state how the practice came to the attention of investigators, but statements from agents who worked on the case indicate they're looking for more offenders.

“When physicians and health care companies provide patients with drugs not approved by the FDA and bill for services provided by those suspended from the Medicare program, they violate the basic trust that is extended to healthcare professionals,” said Special Agent in Charge Derrick L. Jackson of the HHS-OIG’s Atlanta Region. “Our agents continue to work with the Department of Justice to root out such fraud schemes, which undermine the public’s confidence in, and the financial well-being of, federal health care programs.”

Last month, Antioch, Tenn.-based Pain Management Group agreed to pay $312,000 to settle allegations that it violated the false claims act by submitting false claims to Medicare and TennCare when it billed for Botox, Supartz and Eufflexa purchased from foreign suppliers. That practice came to investigators' attention after analysis of the practice’s urine drug testing claims to Medicare identified it as a potential outlier.

Blog Tags: anti-fraud

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