You Get What You Pay For

Pills spilling out of a prescription bottle on 100 dollar paper currency

As most Americans know, having access to affordable pharmaceuticals is a challenge. But circumventing laws to bring unapproved drugs over the border – and then charging the government – is never the answer. A Philadelphia-area doctor has learned this lesson the hard way and could spend the rest of his life in prison. He pleaded guilty last month to federal charges of healthcare fraud and illegally importing and distributing a controlled substance.

The 65-year-old rheumatologist from Havertown, Pennsylvania admitted that he imported non-FDA-approved injectable medications and illegally distributed them to patients. He then billed Medicare and other government programs for the cost. (That required an extra dose of chutzpa for sure.)

The doctor owned and operated three practices between Philadelphia and Wilmington, Del. His practice used expensive live-cell medications like Remicade to treat autoimmune diseases, and Synvisc and Boniva for osteoarthritis. (All are administrated by injection and infusion.)

Rather than buy these expensive, FDA-approved medications from authorized distributors, the doctor instead bought cheaper, non-FDA-approved versions. He illegally imported and distributed the non-FDA-approved medications to his unsuspecting patients. (Apparently, at least two of his patients were simultaneously abusing cocaine and heroin. That’s an accident just waiting to happen.)

The Pennsylvania-based rheumatologist then billed federal healthcare programs and pocketed about $1.1 million in illicit proceeds from his healthcare fraud scheme. He faces up to 70 years in prison and a $2.5 million fine when sentenced. Obviously, Medicare does not pay for non-FDA-approved medications because of the risk to patients. (We can only hope that this doctor loses his medical license so he can’t put anyone else at risk ever again.)

Today’s Fraud of the Day comes from the article, “Haverford doc pleads in foreign medicine scheme,” published Dec. 18, 2019 in The Delaware County Daily Times.

PHILADELPHIA — A Havertown doctor pleaded guilty in federal court Monday to charges that he imported foreign, non-FDA approved injectable medications, then falsely billed health care benefit programs for approximately $2.3 million.

Rheumatologist Dr. Thomas J. Whalen, 65, pleaded to a criminal information charging him with one count of health care fraud, one count of importation contrary to law and two counts of distribution of a controlled substance for unlawfully distributing oxycodone to patients actively using illicit drugs, according to a release from U.S. Attorney William M. McSwain.

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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.