The state is suing Dr. Kakra Gyambibi and her husband, University of Connecticut in Stamford employee Kwasi Gyambibi, for defrauding Connecticut’s employee drug prescription plan.
According to the complaint, filed in Hartford Superior Court under the Connecticut False Claims Act, the Stamford pair engaged in a scheme designed to prescribe expensive, medically unnecessary compounded medications to state employees enrolled in the state employee pharmacy benefit plan. The lawsuit stems from an investigation launched by the Office of the Connecticut Attorney General in 2014 after a request from State Comptroller Kevin Lembo, who administers the State of Connecticut Employee and Retiree Prescription Drug Plan.
“The allegations in this case involve a scheme to take advantage of the state’s prescription drug benefit program by convincing state employees to try prescriptions for very expensive compounded drugs that are then prescribed by a doctor who never established a physician-patient relationship – and who, in fact, never even met face-to-face with the patient,” Attorney General George Jepsen said.
“This doctor utterly failed to adhere to even a minimal prudent standard of care,” he continued, “and therefore this alleged conduct represents not only a serious abdication of her professional and ethical responsibilities but an egregious abuse of the prescription drug benefit plan and the taxpayer dollars that fund it.”
The state’s prescription drug benefit plan provides prescription drug coverage to eligible state employees, retirees and their families. The plan’s guidelines require that prescriptions covered under the plan be “medically necessary” as determined by a licensed practitioner “in accordance with generally accepted standards of medical practice.”
According to the suit, the Gyambibis met on several occasions with a sales representative from Advantage Medical and Pharmaceutical LLC and received marketing materials concerning compounded pharmaceutical preparations created and dispensed by Advantage. They were also provided with Advantage prescription pads that contained common formulations for the compounded pharmaceuticals created and dispensed by Advantage, the state alleges. The business model of Hattiesburg, Miss.-based Advantage uses commission-based marketing representatives to market its products, including compound drugs.
Compounded pharmaceuticals, unlike mass-produced, manufactured pharmaceuticals, are made based on a practitioner’s prescription in which individual ingredients are mixed together in the exact strength and dosage prescribed by the provider; they are not approved by the federal Food and Drug Administration, Jepsen said.
The state alleges that, from June 2014 to at least March 2015, Kwasi Gyambibi sought out and approached his coworkers and convinced them to try compound pharmaceutical prescriptions offered by Advantage for their health ailments, and that Gyambibi assured them that the compounded drugs were effective at treating their condition and that his wife would write the prescriptions for them. The state alleges that, once a coworker agreed to try the compounded drug, Kakra Gyambibi wrote the prescription without examining the patient, and the prescription was submitted to Advantage.
Kakra Gyambibi did not create or maintain any records documenting the care she provided to any patient for whom she prescribed a compounded pharmaceutical, and there is no documentation of an initial examination, plan of care, treatment note or any other medical record to support the prescriptions for the compound pharmaceuticals that she wrote, the state alleges.
Further, the state alleges that a large number of the individuals for whom Kakra Gyambibi prescribed compounded pharmaceuticals never used the prescriptions, yet received numerous and unsolicited refills based on the initial prescription written by Kakra Gyambibi – each costing the state thousands of dollars per refill.