Heritage Operations Group has been vindicated in a whistleblower claim filed by a former Omnicare pharmacist who alleged the Illinois-based nursing home operator violated the False Claims Act by improperly billing Medicare for providing pain medication to patients without valid prescriptions.
In dismissing the lawsuit, Judge Steven C. Seeger of the U.S. District Court for the Northern District of Illinois asserted that plaintiff Samuel Enloe didn’t prove his case.
“The most basic problem with the complaint is that it alleges little more than a failure to comply with regulatory requirements,” Judge Steven C. Seeger of the US District Court for the Northern District of Illinois wrote in an opinion released Thursday. “[Mr.] Enloe basically alleges that Heritage and Green Tree are not complying with the Controlled Substances Act when they dispense medication to residents in the care facilities. That’s about it.
“At best, it sketches the general outline of the story, without filling in very many details,” he added.
An executive with Heritage Operations Group declined to comment to McKnight’s Long-Term Care News until the company’s CEO had time to meet with legal counsel on the outcome of the case. Heritage owns and operates approximately 60 nursing homes in Illinois.
Improper prescribing alleged
According to the whistleblower complaint, nurses at Heritage allegedly dispensed Schedule II controlled substances without obtaining valid prescriptions, “relying on an oral prescription that is not approved by a pharmacist.” Enloe further alleged that the defendants “billed the United States government and the State of Illinois for those medications based solely on physician’s orders, which did not comply with the [legal] requirements … and without obtaining a valid prescription.”
Seeger’s ruling criticized the plaintiff for what he considered a complaint full of procedural errors.
“The complaint doesn’t offer very many details about the alleged fraud. At best, it sketches the general outline of the story, without filling in very many details,” he wrote in his opinion. “The allegations hover at the highest level of generality. There are no concrete allegations about defendants submitting false claims to the United States. The complaint provides no details about when defendants submitted fraudulent claims, or who submitted the false claims on behalf of defendants, or how many claims they submitted, or how much money defendants received, and so on.”
Heritage and its primary pharmacy supplier — Green Tree Pharmacy — are owned by the same company. Enloe’s complaint also alleged that he “lost business” to Heritage because his company incurs the “extraordinary expenses” of complying with the Controlled Substances Act.
The False Claims Act authorizes private parties to bring claims on behalf of the federal government against a defendant who defrauds the United States. Whistleblower actions are typically described as “qui tam” suits, or actions in which private individuals who assist a prosecution can receive for themselves all or part of the damages or financial penalties recovered by the government.
According to court documents, Enloe spent over 20 years working for Omnicare, Inc., a CVS-affiliated pharmacy company that serves nursing home residents. He currently owns and operates Critical Care Pharmacy, which serves the needs of long-term care residents.
In general, a pharmacy must receive a written prescription from a physician before dispensing a Schedule II controlled substance (e.g., opioids) to a patient. In an emergency, a doctor can call in a prescription to a pharmacist, and a pharmacist can dispense a controlled substance to a nurse, so that a resident can receive it right away.
