Pharmacy chain fined after Saskatoon whistleblower reports over-billing

Pharmacy chain fined after Saskatoon whistleblower reports over-billing

Breadcrumb Trail connects Saskatchewan

SRx Pharma Inc. ordered to pay largest fine ever imposed by Sask. College of Pharmacy Professionals; returned just over $70,000 to Indigenous Services Canada.

SFx Pharma Inc. was found to have overcharged Indigenous Services Canada between June 2017 and June 2018 for Epclusa, a drug used to treat hepatitis C. Photo by Hand-out / Gilead Sciences, Inc. Content of article

A national pharmacy chain has been fined for ordering a Saskatoon pharmacist to overcharge Indigenous Services Canada for drugs used to treat hepatitis C.

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Details of the case against SRX Pharma Inc. are contained in a December 2022 decision by a disciplinary committee of the Saskatchewan College of Pharmacy Professionals, the provincial regulator of pharmacists.

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SRx opened its Saskatoon pharmacy location in 2017 under the direction of a pharmacist identified only as “DM” in the decision.

DM first raised concerns about SRX’s billing practices regarding a coverage program operated by Indigenous Services Canada (ISC) in December 2017. He resigned from SRx in January 2018 and filed a formal complaint with the college in February of that year, alleging that SRx had increased drug prices beyond the maximum set by the province and altered bills and falsified costs.

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He included screenshots of text messages between himself and SRx President Adesh Vora, as well as copies of invoices, permit and billing forms.

DM first raised concerns after a patient came to the pharmacy in June 2017 with a prescription for Epclusa, a drug used to treat hepatitis C. Noting a discrepancy between the province’s price for a vial of the drug and the ISC billed, he asked SRX President Adesh Vora if the drug was properly billed. Per the decision, Vora assured DM that everything was fine and that its other Canadian pharmacies had always billed the program this way.

In subsequent messages, DM continued to express concerns that SRx would fail an audit, noting that purchases from drug wholesaler LPG Inventory Solutions were billed at one rate, while billing to ISC exceeded the rates allowed under the Saskatchewan Drug Plan for Hep-C drugs exceeded.

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The billing issue was raised again when DM gave his resignation. The decision says that if DM had been called to testify, he would have reported that Vora said he and his team investigated the hepatitis drug billing situation in Saskatchewan and insisted that a surcharge be allowable under the ISC program be.

The college sent DM’s complaint to ISC, which hired an outside firm to conduct a forensic review of SRx’s billing. The investigation revealed that Vora and an LPG employee had worked together to disguise credits and rebates given by the wholesaler to SRx. The auditors determined that these rebates and credits should have been applied to the price SRx charged the ISC.

They wrote that as a result, ISC was overbilled by at least $73,000 and possibly a little over $265,000.

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Upon receipt of the audit reports, ISC sent a letter to SRx requesting the return of the minimum amount of just over $73,000. SRx complied and paid out the sum in September 2021. The college notified SRx in October 2021 that it would be the subject of a disciplinary hearing over charges that included an overcharge of ISC and directed DM to contact LPG and have bills amended to reflect the maximum cost under the framework of the program and that SRx knew or should have known that it was submitting misleading bills.

SRx pleaded guilty to proprietary misconduct under the Pharmacy and Pharmacy Disciplines Act, a term for conduct harmful to the best interests of the public, members of the College, or the reputation of the pharmacist profession.

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The committee approved a joint submission by SRx and attorneys representing the college’s Appeals and Disciplinary Committees; SRx was ordered to pay a $30,000 fine, the highest ever imposed by the college, according to the joint filing. SRx was also ordered to pay just over $25,000 in costs related to the investigation.

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