Provided by:  Jennifer Kirschenbaum, Esq. 

October 14, 2021


Under the False Claims Act, the Department of Justice fined an Ophthalmologist $450k for delivering an unapproved foreign and cheaper drug to patients with macular degeneration in lieu of providing Lucentis, which is FDA approved, after the doctor billed Medicare as if he had provided Lucentis.  Here, criminal charges also followed for the prescribing of non-FDA approved drugs to patients. “Physicians who provide non-FDA approved drugs to their patients unnecessarily place those patients in their care at risk,” said Special Agent in Charge Jackson.
The above is fairly intentional fraudulent conduct if the codes utilized were specific for Lucentis.  Not sure how the coding could be defensible.  But, there are scenarios that come up that are, perhaps, not so intentional, but questionable. Always look before you leap.