Pharmacy chain fined $30K after Saskatoon pharmacist flagged overbilling of Indigenous Services Canada
The pharmacy chain SRx Pharma has been fined $30,000 for overbilling Indigenous Services Canada for drugs used to treat hepatitis C, after a Saskatoon pharmacist alerted the province's regulatory body to the practice.
It's the largest fine ever handed out by the Saskatchewan College of Pharmacy Professionals, the regulatory body for pharmacists in the province, according to a written decision from a college disciplinary committee.
The overbilling involved marking up hepatitis C drugs over the maximum allowable provincial prices and altering invoices, according to the decision, dated Dec. 27.
It was brought to the attention of the college when the pharmacist at SRx Pharma's Saskatoon location lodged a complaint with the college.
In December 2017 the pharmacist — referred to only as DM in the decision — contacted the college's complaints director with concerns about the billing practices at SRx and the directions he was receiving regarding billing for patients receiving hepatitis C medications though the Non-Insured Health Benefits program, or NIHB.
That federal program provides eligible First Nations and Inuit clients with coverage for a range of health benefits that are not covered through other insurance or social programs.
The pharmacist resigned from SRx Pharma in January 2018, and filed a complaint with the college regarding the billing practices at SRX in February of that year.
A later forensic audit by Indigenous Services found the department had been overbilled between $73,795.40 and $265,458.28, the written decision says.
The department demanded SRx Pharma repay $73,795.40, which it did, according to the decision.
Pharmacist commended
At a college disciplinary committee hearing in late November 2022, SRX pleaded guilty to the accusation of proprietary misconduct.
The disciplinary committee found SRx Pharma directed the pharmacist to submit claims and invoices to Indigenous Service at the maximum allowable costs for pharmaceutical products used to treat hepatitis, when the actual costs for those products were substantially less, the decision reads.
Hepatitis C is a viral infection that affects a patient's liver. If left untreated, chronic hepatitis C can cause serious complications, such as liver failure and liver cancer.
It can be treated through medication, but the cost for those medications can be significant.
The Saskatchewan pharmacy college's decision said the the president of SRx Pharma, Adesh Vora, directed the pharmacist to "contact the drug wholesaler to have the invoices altered to match the NIHB maximum allowable cost of the prescription product."
The pharmacist was also told to submit these claims and invoices when the company knew or ought to have known that the claims and invoices were misleading, according to the decision.
It says the "company provided false and misleading information to the pharmacy manager DM regarding the billing processes of the NIHB Program."
"You interfered with and did not allow the pharmacy manager DM to exercise their authority and responsibility in operating the pharmacy and specifically, in managing the billing processes of these pharmaceutical products."
The decision also said the pharmacist, who was "an unwilling participant in SRX's misconduct," was to be commended for brining the issue to the college's attention.
"The discipline committee notes that, but for DM's actions, SRX would likely have been permitted to continue its deceitful billing practices," the decision read.
Along with the fine, the college ordered SRx Pharma to pay more than $25,000 in court costs.
CBC has contacted SRx with a request for comment.
CBC also asked Indigenous Services Canada for comment, but was told no one from the department could immediately provide a response to the decision.
