Saskatoon pharmacy fined for overcharging government agency thousands of dollars

A Saskatoon pharmacy has been ordered to pay over $55,000 after admitting guilt for improper billing of medications.

According to a disciplinary committee hearing of the Saskatchewan College of Pharmacy Professionals held Nov. 30, the pharmacy manager of SRx Health Solutions resigned over the matter and filed a grievance with the college.

“In December 2017, Lori Postnikoff, then the College Complaints Director, had three phone conversations with DM (Pharmacy Manager). DM expressed concern about SRX’s billing practices and the instructions it received from Mr. Vora (pharmacy owner) regarding billing for NIHB patients who received hepatitis C medication,” read a note of the reasons for the decision committee.

The document does not name the manager.

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

The document said the pharmacy director had been instructed to submit claims and bills for the maximum charges under the NIHB program for hepatitis treatments. The actual cost of the products was “substantially less” than what the pharmacy had charged.

In the complaint, the pharmacy manager said that SRx Health Solutions “prices expensive drugs above the maximum allowable provincial prices and exploits a loophole in the NIHB ruling, amends bills for audit purposes, and falsifies actual purchase costs.”

As a result of the complaint, Indigenous Services Canada conducted forensic audits of the pharmacy. Ernest Young was hired to conduct a forensic examination and they found that the pharmacy had overcharged thousands.

“Based on our review, the NIHB may have been charged an overcharge of between $73,795.40 and $265,458.28 due to drug cost claims over incurred billing costs and post-issued credits,” the hearing filings read.

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

In his defense, pharmacy owner Adesh Vora said that he and his time examined how billing is handled in Saskatchewan 50 times and found that a 7.5 percent mark-up was allowed by the NIHB.

“In subsequent discussions, Mr. Vora reinforced this statement by noting that his other pharmacies billed hepatitis C drugs for NIHB at the maximum allowable unit cost,” the hearing document said.

It was also determined that Vora was part of a disciplinary proceeding by the Ontario College of Pharmacists for various matters, including improper NIHB billing practices, the document said.

However, the hearing document noted that the pharmacy pleaded guilty to the allegations.

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

The hearing took place on December 27 in Swift Current.

According to the documents, the pharmacy was granted a university license on June 14, 2017.