A former Clinical Pharmacy Manager at a Walgreens specialty pharmacy pleaded guilty to health care fraud crimes committed between October 2014 and April 2016.
Amber Reilly, a Tennessee pharmacist, admitted to falsifying prior authorizations, medical lab reports, and drug test results for at least 51 hepatitis C patients who were prescribed expensive hepatitis C drugs Sovaldi, Harvoni, Viekira Pak, and Daklinza.
Although the patients’ authentic lab reports and drug tests showed that they failed to meet TennCare eligibility requirements, Reilly replaced the disqualifying information with qualifying information. TennCare does not pay for hepatitis C prescriptions for patients who are shown to abuse illicit substances or who have limited or no liver scarring. Reilly fabricated the patients’ test results in order to eliminate disqualifying information, and then submitted the fraudulent records to TennCare.
Reilly also admitted to falsifying allergies on prior authorization forms for some patients so that they could receive Harvoni, which is the most expensive hepatitis C drug.
As a result, TennCare paid at least $4,400,000 to purchase hepatitis C prescriptions for these 51 patients. Reilly is set for sentencing on January 30, 2017. If convicted, she faces a potential sentence of up to 10 years in prison, a $250,000 fine, and supervised release of up to 3 years.