P.A.B. Pharmacy, Inc.
Outcome
P.A.B. Pharmacy settled for $551,549.20 and received affirmative exclusions for submitting Medicare Part D claims for antiretroviral HIV drugs including Prezista, Atripla, Isentress, and Descovy that were not in inventory and never dispensed to patients.
Details
P.A.B. Pharmacy (Brooklyn, NY) — HIV Antiretroviral Drugs Never Dispensed
Outcome: Settled for $551,549.20 and received affirmative OIG exclusions for submitting Medicare Part D claims for HIV antiretroviral medications — Prezista 600, Prezista 800, Atripla, Isentress, and Descovy — that the pharmacy did not have in inventory and never dispensed to patients.
P.A.B. Pharmacy, Inc. of Brooklyn, New York, submitted false claims to Medicare Part D for multiple high-cost antiretroviral drugs used to treat HIV. The pharmacy billed Medicare Part D as if it had dispensed these medications to beneficiaries when in fact the drugs were not in the pharmacy's inventory and were never delivered to patients.
The specific drugs involved — Prezista (darunavir), Atripla, Isentress (raltegravir), and Descovy — are all high-reimbursement HIV antiretroviral medications, making billing for undispensed units particularly lucrative. The OIG imposed both civil monetary penalties ($551,549.20) and affirmative exclusions, settled November 21, 2022.
How Crucible Prevents This
Crucible's inventory-to-billing reconciliation controls would catch HIV antiretroviral billing with no corresponding purchase inventory; automated matching of wholesaler HIV drug invoices against Medicare Part D claim submissions would flag billing for Prezista or Atripla without confirmed purchase and dispensing records.
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