In total, GEICO is seeking to recover $105,844 in damages that it claims the defendant stole. (Credit: andreyphoto63/Adobe Stock)
GEICO filed suit against R Family Pharmacy in New York on March 4, alleging they committed ongoing fraud against the insurer by exploiting the state’s no-fault auto insurance system. The insurer claims the pharmacy submitted more than $2 million in fraudulent pharmaceutical billing to GEICO.
The complaint reads, in part: “The Defendants’ scheme overwhelmingly targeted expensive topical prescription drug products, which they systematically dispensed to individuals involved in automobile accidents and eligible for insurance coverage under policies of insurance issued by GEICO (“Insureds”) without regard to genuine patient care.As part of the fraudulent scheme and to maximize their profits, the Defendants exploited the patients and colluded to have large volumes of medically unnecessary prescriptions steered to R Family Pharmacy.”
GEICO alleges these actions are part of the pharmacy’s involvement in a larger-scale fraud scheme, with the intent to exploit patients for financial gain. They claim R Family Pharmacy entered into “illegal, collusive” arrangements with prescribing healthcare providers and other unlicensed personnel who operated multidisciplinary medical clinics that treated mostly no-fault claim patients.
The clinic reportedly prescribed large volumes of topical pain medication – specifically, Diclofenac Gel 3% and Lidocaine 5% ointment – with these prescriptions directed to R Family Pharmacy. GEICO’s suit repeatedly refers to these topical treatments as “fraudulent topical pain products.”
The suit claims that R Family Pharmacy received thousands of medically unnecessary prescriptions for these topicals and dispensed them to insureds in place of other effective, but less expensive prescription and non-prescription products.
GEICO claims that nearly 97% of the billing R Family Pharmacy submitted to them was the Diclofenac Gel 3% and Lidocaine 5% ointment. Prescriptions for the Diclofenac average $2,359 each, with a prescription for the Lidocaine coming in around $1,905.
In total, GEICO is seeking to recover $105,844 in damages that it claims the defendant stole. The insurer also wants a declaration that GEICO is not legally obligated to reimburse over $1.7 million in pending “fraudulent” no-fault claims from R Family Pharmacy.
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