After reading through more transcripts, analysis, powerpoints, investor calls and letters than I could ever want, I found that I still had a fever....and the only prescription was more cowbell.
Turns out, that additional analysis of accounts receivable data generated by Philidor has uncovered an odd subset of prescriptions which apparently were never meant to be filled.
As is to be expected of Valeant, it's not straightforward so let's keep it as simple and rhythmic as possible.
On June 23rd, Philidor claims that prescription 40031052 was dispensed and shipped. Philidor's records also show that they are due $973.21 from the the PBM/Processor Caremark.
What is quite odd about this particular receivable is the shipping history associated with this prescription. Instead of originating at R&O on June 23rd, it actually originates in Hammond, Indiana on June 29th, before making its way to R&O in Camarillo, California, where it was received on July 2nd and signed for by "Al." This is troubling for many reasons. At first I thought perhaps it was a return, but that can't be the case, because it's a credit on the receivables. It would also stand to reason that if it were a return, the same exact script number would be referenced with a reimbursement due to Caremark, but this is the only reference to prescription 40031052.
In an even stranger twist there are prescriptions which appear to be billed to payors, but were never shipped into or out of R&O. It's like the Wonka factory for price gouged drugs. As seen here, prescription 40045409 claims to have been filled on July 6th, and shipped on July 7th, with the payor on the hook for $1017.30.
When you refer to the shipping history for that particular prescription though, you can see it wasn't even scheduled to be picked up until July 9th at 7:46pm, and the scheduled pickup was from Oak Park, IL, destined for Camarillo, California. It never got there though. You can see from its shipping history that it wasn't even scanned in by UPS.
More troubling still for Philidor and Valeant is that these two simple examples are not the only examples uncovered in their accounts receivables. These are just two little plunks of the stick on the cowbell.
Using other pharmacy's provider numbers seems bad enough, but billing for prescriptions which were never filled seems like outright insurance fraud, which would be in addition to whatever insurance fruad they were already perpetrating.
Plunk, plunk, plunk, plunk, plunk, plunk, plunk...
All our times have come.....
For those curious, the origins of these phantom shipments I've uncovered thus far are:
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Do you know "UPS recycles tracking number"
ReplyDeleteDoes The Skeptic21 also have documents from the Texas Air National Guard proving George W. Bush was AWOL?
ReplyDeleteI'm not sure how to interpret this data. At first glance, it looks like Valeant bills the insurance company for a prescription, and then bills the insurance company again for a return as if it is a refill. Maybe prison will give Pearson a chance to lose weight.
ReplyDeleteSkeptic – your post is very misleading. Having completed the comprehensive analysis of the invoices - analyzing ~25k separate shipments, I can tell you the overwhelming majority of shipments - 99.7% - were delivered as planned. Of the 81 out of 25,000 that were not completed there was nothing nefarious. UPS included rather mundane explanations. For example the code you mentioned as not ever being shipped (1ZX101A68741502244) has the following status: BILLING INFORMATION RECEIVED. THE DELIVERY CHANGE FOR THIS PACKAGE WAS COMPLETED. / THE SENDER REQUESTED THAT WE RETURN THIS PACKAGE.
ReplyDeleteOf the 0.3% of the shipments that had a status other than Delivered, the causes were generally things like cancellations, returns, or change of address. There isn’t anything suspicious about this.
To give you a few other examples of status descriptions for these 81 that weren’t marked “Delivered”, here are 3 others:
THE RECEIVER WAS NOT AVAILABLE AT THE TIME OF THE FIRST DELIVERY ATTEMPT. A SECOND ATTEMPT WILL BE MADE.
THE STREET NAME IS INCORRECT. THIS MAY DELAY DELIVERY. WE'RE ATTEMPTING TO UPDATE THE ADDRESS. / THE PACKAGE WILL BE RETURNED TO THE SENDER.
THE STREET NUMBER IS INCORRECT. THIS MAY DELAY DELIVERY. WE'RE ATTEMPTING TO UPDATE THE ADDRESS. / THE PACKAGE WILL BE RETURNED TO THE SENDER.
The other point that I would make is that we are looking at invoices between R&O and VRX as a snapshot in time. We don’t have the follow up audits and reconciliations. It’s likely that returns or cancelations were in fact reconciled and adjusted. But most important we need to have the proper context. We are talking about 0.3% of the shipments. This is no scheme here …..or “plunk plunk plunk” that you ask your readers to extrapolate from your 2 data points.
What I find troubling is that you either did NOT analyze all 25,000 transactions (i.e laziness, or lack of technical ability) and drew conclusions from just 2 invoices with no broader context, or worse you did the full analysis, and then tried to mislead us by making an argument out of 0.3% and providing no context to your readers.
As a regular reader of your blog, I’ll assume it was the former. Helpful suggestion: As many readers won’t make it to the comment section, it would be helpful to others if you corrected the body of your text to note that 99.7% of the shipments were received as planned and you post is about the 2 of the 81 out of 25,000 that were not delivered. 99.7% were delivered. Many thanks.