Healing Corner: Vivitrol Ordered for One Patient and Sold to Another

The Healing Corner fraud case produced a $2,346,545 default judgment against the clinic and its sole practitioner over Vivitrol ordered in former patients’ names and billed to Medicaid. The government alleged that the clinic ordered medication in former patients’ names, stockpiled it and administered it to cash-paying patients. If you handled refills, deliveries or claims, that split between the name on the prescription and the person receiving the injection is the part of this case you may recognize.

Vivitrol Ordered in Former Patients’ Names

According to the United States and Wisconsin’s joint complaint, as described in the Justice Department’s announcement, Healing Corner kept ordering Vivitrol in former patients’ names at its sole practitioner’s direction. Wisconsin Medicaid reimbursed those prescriptions, while the medication accumulated at the clinic for use on other patients.

The drug and its delivery route explain the opportunity. Vivitrol treats alcohol dependence and helps prevent relapse to opioid dependence. A health care professional administers it monthly.

The government alleged that Healing Corner prescribed Vivitrol, requested refills and received deliveries from a specialty pharmacy, but routinely did not administer the medication to the patient for whom it had been prescribed. The alleged decision sat inside the clinic: its sole practitioner directed the use of former patients’ names to obtain more medication.

A prescription and a delivery can both exist while the patient named on them receives nothing. Here, the government traced the alleged misuse beyond the order itself to the stockpile and the people who ultimately received injections.

The announcement described Wisconsin Medicaid reimbursement of approximately $1,600 per injection. According to the government, the stockpiled medication went to non-Medicaid patients who often paid Healing Corner more than $1,000 out of pocket per month. We see the absurdity: Medicaid financed the stock, and the clinic charged someone else to receive it.

Free Samples Billed to Medicaid

The government also alleged that Healing Corner administered free Vivitrol samples to Medicaid patients and still submitted claims to Medicaid for reimbursement. This part of the case followed a different path: the patient received an injection, but the medication came from a free sample.

For someone working inside a practice, the distinction is concrete. You may know that a dose came from sample stock, while someone handling claims sees a request for reimbursement. We connect those accounts because the government’s allegation concerns both the medication’s source and the bill submitted for it.

The Payment Rule Follows the Claim

Medication, a professional visit and a treatment bundle represent different things on a bill. Healing Corner’s case centered on Wisconsin Medicaid reimbursement for Vivitrol prescriptions and claims involving free samples.

Elsewhere in addiction treatment, the payment unit changes. CMS’s office-based treatment guidance describes professional services and a monthly substance use disorder management bundle. Counseling is part of that monthly bundle.

At Healing Corner, the government’s account followed the prescription through a specialty pharmacy to the clinic and then to the person receiving the drug. That is a specific payment trail an employee handling only one part of the transaction may help explain.

The Default Judgment Against the Clinic and Its Practitioner

On March 2, 2023, the federal district court in the Eastern District of Wisconsin entered default judgment against Healing Corner LLC and its sole practitioner for False Claims Act violations.

A former patient’s stepfather brought the whistleblower claims included in that resolution. The patient had neither requested nor received the multiple Vivitrol prescriptions Healing Corner ordered in the patient’s name. That personal knowledge connected a familiar name to medication that went elsewhere. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

The Justice Department credited a coordinated effort by the U.S. Attorney’s Office for the Eastern District of Wisconsin, the U.S. Department of Health and Human Services Office of Inspector General, and the Wisconsin Department of Justice.

Other Medication Cases Expose Different False Claims

The same distinction between supplying medication and billing for treatment appears in other addiction-treatment cases. Each turns on what the particular claim represented.

In the case against The Journey to Hope, Health and Healing, the government alleged that Rhode Island Medicaid claims for bundled methadone treatment lacked required individualized treatment plans or counseling.

At Ultimate Treatment Center, the government alleged billing for evaluation-and-management encounters that did not happen, including dates when a patient had take-home medication.

Healing Corner adds the prescription’s patient identity and the source of the medication to that picture. We look for the connection between the treatment people actually received and the transaction the government paid for. An insider who knows how a refill was ordered, where a dose came from or why a claim was submitted may hold the detail that makes that connection clear.

You Know Whose Medication It Was

If prescriptions kept arriving for former patients or free samples became Medicaid claims, talk with our whistleblower experts about the practice you know. We work beside you to build your strongest Medicaid whistleblower case around the orders, patient identities and payments, and bring in healthcare fraud whistleblower lawyers who understand medication billing. From the first conversation through the case, we stay on your side of the table.