Saskatoon pharmacy fined for overcharging government agency thousands of dollars

A pharmacist is seen checking inventory at an unknown pharmacy. (Shutterstock.com)

A Saskatoon pharmacy has been ordered to pay over $55,000 after acknowledging its guilt for improperly billing for medications.

According to a discipline committee of the Saskatchewan College of Pharmacy Professionals hearing held on November 30, the SRx Health Solutions pharmacy manager resigned over the issue and filed a complaint with the college.

“In December 2017, Lori Postnikoff, who was then the Complaints Director with the College, had three telephone conversations with DM (pharmacy manager). DM expressed concerns about the billing practices at SRX and the directions he was receiving from Mr. Vora (pharmacy owner) regarding billing for NIHB patients receiving hepatitis C medications,” a record of the reasons behind the committee's decision said.

The document does not name the manager.

“Non-Insured Health Benefits (NIHB) is a program within Indigenous Services Canada. The NIHB program provides eligible First Nations and Inuit clients with coverage for a range of health benefits including prescription medications.”

The document said that the pharmacy manager had been directed to submit claims and invoices for the maximum costs under the NIHB program for hepatitis treatments. The actual costs for the products were” substantially less” than what the pharmacy was billing for.

In the complaint, the pharmacy manager said SRx Health Solutions was “marking up expensive medications over the maximum allowed provincial prices and exploiting a loophole in the NIHB adjudication, and altering invoices for audit purposes, and falsifying actual acquisition costs.”

As a result of the complaint, Indigenous Services Canada conducted forensic audits of the pharmacy. Ernest Young was hired to complete a forensic audit, and they determined thousands had been overbilled by the pharmacy.

“Based on our review, NIHB was potentially overbilled between $73,795.40 and $265,458.28 as a result of drug costs claims in excess of the invoice cost incurred and subsequent credits issued,” the hearing documents said.

As a result, Indigenous Services Canada sent a demand letter to the pharmacy for a payment of $73,795.40. The pharmacy paid the money in 2021.

In his defence, the pharmacy owner, Adesh Vora said that he and his time had looked into how billing was handled in Saskatchewan 50 times and determined a 7.5 per cent markup through NIHB was allowed.

“In subsequent discussions, Mr. Vora reinforced that statement, advising that in his other pharmacies, hepatitis C drugs for NIHB were billed to the maximum allowable unit cost,” the hearing document said.

It was also noted that Vora had been part of disciplinary proceedings by the Ontario College of Pharmacists for several things, including improper NIHB billing practices, the document said.

However, the hearing document noted that the pharmacy entered a guilty plea to the allegations.

The college fined SRx Health Solutions $30,000 and a further $25,875 to cover the costs of the investigation and hearing.

The hearing was held on December 27 in Swift Current.

The pharmacy was issued a college permit on June 14, 2017, according to the documents.