Kohlerman’s patients sought to fill prescriptions of brand-name Lipitor and its generic equivalent, atorvastatin calcium. Regardless of their need, and often without their knowledge, Kohlerman enrolled the vast majority of these patients in Manufacturer One’s Lipitor Savings Card coupon program. Under the coupon program, Kohlerman billed a patient’s private insurance and then submitted a secondary claim to Manufacturer One for payment to his pharmacy in a scheme to defraud the coupon program.

In order to carry out his scheme, Kohlerman purchased a negligible quantity of brand-name Lipitor for his pharmacy and significant quantities of its much cheaper generic equivalent. Kohlerman dispensed the generic equivalent in bottles with brand-name Lipitor on the labels and then submitted claims to Manufacturer One for reimbursement for the brand-name drug that he neither purchased nor dispensed.

To maximize his fraudulent returns, Kohlerman created fake prescriptions for Lipitor — that neither he nor his pharmacy dispensed — and submitted claims for those fake prescriptions to the Program.

Kohlerman also changed physician-issued, one-month supply prescriptions of Lipitor to a three-month supply prescription to triple the fraudulent refund he would receive from Manufacturer One.

Additionally, Kohlerman altered legitimate prescriptions that permitted generic substitution to require distribution of the brand name drug, all while he filled actual brand-only prescriptions with the generic equivalent. Kohlerman submitted false and fraudulent claims to Manufacturer One of $4,562,834.97 and was paid $1,696,566.22.

As part of his scheme, Kohlerman also submitted approximately 126 false and fraudulent Lipitor claims to the Medicare program, approximately two false and fraudulent Lipitor claims to the Medicaid program, and approximately 18 false and fraudulent Lipitor claims to federal employee health benefits programs paid for by the Office of Personnel Management (OPM).

Kohlerman was reimbursed $106,986.70 from Medicare, $2,686.60 from Medicaid, and $5,600.31 from OPM.

In addition to the wire fraud scheme, Kohlerman also ignored suspicious activity on 14 separate occasions and, in each instance, distributed or caused to be distributed 120 oxycodone 30 mg tablets to a purported pharmacy customer. The customer, however, was not the individual for whom the oxycodone was prescribed.

Additional warning signs that Kohlerman ignored included: the quantity of narcotics exceeded Center for Disease Control recommendations for standard medical usage; both the customer and the purported patient lived over 45 minutes away from the pharmacy; the purported patient’s prescribing physician practiced a similar distance away; the purported patient never picked up his/her prescriptions in person and did not visit the pharmacy in person; and the customer filled prescriptions on behalf of the purported patient before they were eligible for refills.

Finally, as part of a civil resolution, Kohlerman and Kohlerman Pharmacy have agreed to pay the United States $300,000 to resolve allegations that both Kohlerman and the pharmacy submitted or caused the submission of approximately 146 false claims for Lipitor when they had, in fact, substituted the generic equivalent for those claims.

The civil allegations against Kohlerman Pharmacy are allegations only and there has been no finding of liability as to the pharmacy.

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