May 3, 2011
Jefferson City, Mo.— Attorney General Chris Koster today announced a settlement with Christopher Geronsin, Inc. d/b/a Beverly Hills Pharmacy, located in St. Louis, Missouri. The settlement resolves allegations concerning Beverly Hills Pharmacy’s Medicaid billing practices from 2006 through 2010.
The Attorney General’s Medicaid Fraud Control Unit alleged that Beverly Hills Pharmacy helped as many as 200 Medicaid recipients meet their spend-down requirements and subsequently improperly submitted claims to Medicaid for reimbursement. These same claims were submitted to the Missouri Division of Family Services to meet a Medicaid recipient’s spend-down amounts and knowingly contained incorrect dates of service. Medicaid provides medical services for individuals who have an income below 85% of the federal poverty level. People above that limit must incur medical expenses equal to the amount their income exceeds that limit before they become eligible. Medicaid regulations prohibit reimbursement for items used to meet an individual’s spend-down amount. Beverly Hills Pharmacy’s actions resulted in billing for services for which it was not entitled to receive payment.
The agreement requires Beverly Hills Pharmacy to pay $235,060 restitution, $235,060 in damages, a $25,000 civil penalty, and $4,880 for the costs of the investigation, totaling $500,000. Beverly Hills Pharmacy further agreed to comply with all Medicaid rules and regulations, including all spend-down requirements from and after the date of the agreement. The agreement contains no admission of liability by Beverly Hills Pharmacy.
"One of my top priorities as Attorney General is to pursue, prosecute, penalize and prevent fraud and abuse of Missouri’s Medicaid Health Care System," Koster said. “We will continue to search for companies and individuals who engage in this behavior and recover the monies rightfully belonging to the people of Missouri.”
Koster said citizens should report suspected Medicaid provider fraud or abuse and neglect to his Medicaid Fraud Hotline toll free at 800-286-3932, e-mail the complaint to firstname.lastname@example.org or complete a complaint form at the Attorney General’s Medicaid Fraud Website at http://ago.mo.gov/divisions/medicaid-fraud-control-unit-faqs.htm.