Ven-A-Care chases down Medicare defrauders, collects bounties

Ven-a-Care busts drug companies for Medicare fraud. CC by http://www.medicare.gov/Wikimedia Commons

It’s not every day a small pharmacy generates $168.7 million in annual revenue., but the Los Angeles Times reports that the specialty pharmacy Ven-A-Care of Florida Keys, Inc., is no mere small pharmacy. The company acts as a whistle-blower that reports the misdeeds of pharmaceutical companies that overbill Medicare and Medicaid. While the company has been called a “professional bounty-seeker” by critics, the truth is is that tens of millions of taxpayer dollars are at stake.

Purpose of Ven-A-Care

In its whistle-blower capacity, Ven-A-Care researches the price it pays for drugs versus those reported by big pharmaceuticals to the federal government for reimbursement purposes. Ven-A-Care is able to file a lawsuit for the U.S. government if there is a discrepancy.

For example, a 2005 case involved a 1-gram vial of vancomycin. Medi-Cal was charged $58.37 for it while pharmacies were charged $6.29 each. In another case, the medication atenolol charged Medi-Cal $70.30 while pharmacies only paid $3.05 for 50-milligram tablets. These examples are just the tip of the iceberg, says that Los Angeles Times. The State of California has recovered at least $95 million of late, thanks to Ven-A-Care’s efforts.

“I think Ven-A-Care has played a predominant role in alerting state and federal governments about … fraud,” said California Supervising Deputy Attorney General Nicholas Paul.

How the Ven-A-Care cases work

Since 2000, about 18 health insurance over-billing cases have been won by Ven-A-Care. While the small pharmacy has collected about $380 million in bounty funds, state and federal governments across the U.S. have pulled in about $2.2 billion.

“(Ven-A-Care is) cleaning up a huge cesspool,” said Nevada attorney and former Medicaid fraud investigator L. Timothy Terry. “Without their efforts, taxpayers would be gouged out of I don’t know how much money.”

Making sure payments have a cap

Insiders like former federal healthcare fraud investigator Michael Loucks believe that companies like Ven-A-Care are taking advantage of a near-limitless jackpot system. Now a defense attorney, Loucks told the Times that a $2 million cap should be instituted, large enough to still encourage whistle-blowers, but small enough to keep the government’s expense under control.

Jin Breen is the attorney for Ven-A-Care. He says that the cap won’t work. A big return has to be paid out because of the amount of legal costs that come when pursuing big pharmaceuticals.

Citations

Los Angeles Times

Medicare fraud hurts U.S. taxpayers