How an Online Pharmacy Sold Millions of Dollars in Doubtful COVID-19 Drugs — Patients were the ones who paid the price

How an Online Pharmacy Sold Millions of Dollars in Doubtful COVID-19 Drugs
Photo by Szymon Shields from Pexels/How an Online Pharmacy Sold Millions of Dollars in Doubtful COVI...

The network of pharmacies controlled by businessmen Alpesh and Manish Patel was suffering before the COVID-19 outbreak.

Due to rising indebtedness and mismanagement, at least 15 of the company’s 82 pharmacies were closed or sold. It was hit with lawsuits alleging that it owed pharmaceutical suppliers and delivery firms millions of dollars. Employees and patients began accusing the corporation of deception. Federal law enforcement agents were questioning some of the departing employees. Two top executives, including Manish Patel, had already been forbidden from doing business with federal healthcare programs due to allegations ranging from racketeering to conspiracy to paying illegal bribes.

On the other hand, the pandemic presented an opportunity: looser guidelines for telemedicine and long-distance prescription writing, along with a surge in demand for experimental COVID-19 treatments, could mean big bucks. And the Patels were quick to seize the opportunity.

They were able to take advantage of a monetary infusion from the federal government, to begin with. According to an analysis of corporate records shared with TIME by Reason and Results, a Texas-based medical litigation support firm, companies registered to the Patels received at least $7 million in loans from the federal government’s Paycheck Protection Program between the start of the pandemic in March 2020 and April 2021.

The Patels then secretly changed the name of one of their struggling pharmacy enterprises in Auburndale, Fla., in October 2020 to distance it from a prior multi-million dollar settlement for filling false prescriptions. Ravkoo was the new name for the relaunched digital pharmacy. A relationship with America’s Frontline Doctors (AFLD), a controversial right-wing political group, would soon become a significant player in a flourishing industry that fills telemedicine prescriptions for fake COVID-19 therapies like ivermectin and hydroxychloroquine.

According to newly leaked data revealed by The Intercept, Ravkoo filled at least 340,000 prescriptions between November 2020 and September 2021, costing an estimated $8.5 million in drug prices. According to the leaked data, over half of the prescriptions were for ivermectin or hydroxychloroquine; another 30% were for zinc or azithromycin, two other treatments that health officials believe are ineffective in treating or preventing COVID-19, but that anti-vaccine groups have been promoting.

For these COVID-19 “miracle medications,” Ravkoo frequently charged patients exorbitant amounts. According to hundreds of comments in anti-vaccine Telegram and Facebook groups reviewed by TIME, the company was overwhelmed by demand, leaving hundreds of patients in the lurch. In addition, the medication did not always arrive on schedule. Many people said they tried desperately to contact Ravkoo as they or their family members became sicker while waiting for the prescription rather than going to the doctor. One client posted on Ravkoo’s Facebook page on Aug. 18: “I called, emailed, and texted Ravkoo over a dozen times with zero help.” According to the social media posts, others who had previously paid $90 for a telemedicine consultation couldn’t afford Ravkoo’s ivermectin prices, forcing them to use a horse-specific form of the anti-parasitic prescription.

The example of how Ravkoo rebranded as an ivermectin provider demonstrates how the pandemic has hastened the telemedicine boom, leaving patients exposed. For more than a year, US health officials have warned that “rogue web pharmacies” could take advantage of disinformation and medical skepticism to offer untested and potentially deadly prescription medications to treat COVID-19. Despite this, a TIME investigation based on public records and over two dozen interviews with former employees, customers, pharmacists, and law enforcement officials reveals how easy it was for a company whose owners have a history of legal challenges to secure taxpayer funds to prop up a business distributing questionable drugs to misinformed patients.

So far, there appear to be little ramifications. Ravkoo has been on a hiring binge, and he just engaged a Washington consulting firm specializing in corporate reputation management. According to a response it filed to concerns filed with the Better Business Bureau, it’s currently working with a hiring firm to keep up with rising prescription demand (BBB). Moreover, while US agencies claim to have been cracking down on suspect web pharmacies during the pandemic, Ravkoo and its parent firm have yet to receive any publicly posted warning letters.

In response to TIME, a Ravkoo spokeswoman said, “Ravkoo strives to assist advance the health of patients and is committed to a compliance procedure that is commensurate with industry standards.” However, Ravkoo’s CEO, Alpesh Patel, did not reply to many requests for comment over six weeks. The company also neglected to answer questions regarding its business strategy, litigation and investigations, and detailed charges of fraud by former workers.

Ravkoo’s case, according to Libby Baney, a senior consultant for the nonprofit Alliance for Safe Online Pharmacies, is a cautionary tale for a developing sector. According to research released last year, there are more than 35,000 active online pharmacies around the world, with 96% of them operating in violation of state or federal law and relevant pharmacy practice guidelines. According to the survey, 100% of online searches for pharmaceuticals return links to illegal pharmacies. Some vendors offer medicine without a prescription, while others operate without a license or sell counterfeit medications.

“Click here, talk to a doctor in another state, and acquire a prescription.” “Perhaps it comes from some source; maybe it doesn’t,” Baney speculates. “This type of business strategy might produce a lot of confusion among patients and, in the end, cause harm.”

Alpesh Patel, then 34, was marketing himself as the embodiment of an American success story five years ago. He was on a media tour to promote Benzer Pharmacy, a chain of independent pharmacies competing with industry behemoths. In a 2016 interview, Patel stated, “That’s why Benzer exists.” “To provide mom-and-pop pharmacies the resources, they require… to put them on an equal footing with large-scale corporations.”

In a series of interviews in 2016, the Florida-based CEO described how he moved to the United States from India a decade ago to be with his American wife. He worked as a delivery driver till he became a licensed pharmacist in Michigan after graduating from a pharmaceutical school in Gujarat. Patel got a job at Walgreens soon after, but he didn’t like the culture of giant corporate pharmacies, according to him. So, in 2009, he teamed up with Manish Patel, a former Benzer employee who claims to be his cousin, to launch the first of their independent pharmacies in Flint, Michigan.

Alpesh Patel has big ambitions for the future. “We’re going to a lot of baby boomers who opened their pharmacies 30, 40 years ago and are now getting ready to retire, so we’re acquiring their stores,” Benzer told the Tampa Business Journal, adding that Benzer was buying up to four pharmacies a month and hoped to expand to 600 locations. Patel was named one of the “40 under 40” in the Tampa Bay area in 2017, in a story that outlined how he grew the company’s annual revenue to $234 million.

This gleaming exterior, however, did not tell the whole tale. While Patel was the company’s public face, many of its top executives had been charged with crimes.

Manish Patel, Benzer’s president, was charged in 2008 in a Michigan district court with conspiring to cheat Medicare and Medicaid by operating a large-scale prescription drug mill. In addition, Vinesh Darji, the president of Benzer’s franchising business, was found guilty in 2012 by a federal jury in Ohio of unlawfully distributing opioids as part of a drug conspiracy that prosecutors claimed shipped millions of dollars worth of addictive prescription medicines to all 50 states.

Cordera Hill, Benzer’s chief of human resources, was sentenced to 24 months in federal prison in 2017 after being found guilty of conspiring and paying unlawful bribes in a scheme to defraud Tricare, the government-sponsored insurance program for troops, veterans, and their families. In addition, Manish Patel and Hill were both on the Department of Health and Human Services’ “exclusions list,” a group of people forbidden from working with federal healthcare programs because they “represent unacceptable risks to patient safety and/or program fraud.”

In 2016, two Benzer pharmacies agreed to pay the federal government $750,000 to settle charges. They defrauded Medicare and Medicaid by dispensing cheaper generic pharmaceuticals instead of prescription medications and pocketing the difference. According to the Department of Justice, OHM Pharmacy—the company that was eventually rebranded as Ravkoo—paid the federal government $4.1 million in a settlement for falsely billing Tricare.

Despite this, according to data provided by Reason and Results, a medical litigation support organization, the Patels were able to develop a network of up to 160 health companies and pharmacies. Pursuing the Patels was likened to a game of whack-a-mole by one former prosecutor who worked on the OHM case. “It was a well-coordinated attempt to move from one pharmaceutical scheme to the next,” says the former prosecutor, who requested anonymity because he continues to work in the sector.

Benzer boasted 82 locations and 650 employees by 2020. Despite this, many of the pharmacies it acquired were in trouble. Supply concerns and exorbitant costs were frequently mentioned in online evaluations. For example, things went so bad at a local pharmacy acquired by Benzer in Yellow Springs, Ohio, that the manager and another pharmacist departed after they were unable to fill long-term patients’ prescriptions. In addition, employees at Benzer’s corporate headquarters in Tampa submitted negative company assessments on public forums, including high turnover, rejected checks, and a concerning lack of transparency. In November of this year, one employee said, “They cheat people daily.” In a review of Benzer on the job site Indeed, another former employee accused the Patels of “shady side enterprises, mishandling of cash, and scamming the health system.”

TIME spoke with two former corporate employees who described a corporation obsessed with its public image and pressured staff to submit positive online reviews. They said that the company’s human resources department routinely deleted files and papers related to its operations. In addition, employees were banned from speaking with local drugstore owners who sought assistance. One former employee claims, “This corporation is all about optics.” “They’re only concerned with how it appears from the outside.” In addition, employees told TIME that they suspected the corporation did not pay their healthcare benefits with the money deducted from their paychecks.

Former regional manager Chris Lenz said corporate mismanagement of the 11 pharmacies he oversaw in Ohio cost lives. “Because of the association with Benzer [and] Alpesh and Manny’s methods, real lives of local medical professionals are being torn apart, and careers are being damaged,” Lenz adds.

Benzer sacked all of its regional managers in early 2020 and sold or closed 15 of its 82 locations, according to former employees. This, according to Lenz, was in part due to “individual inquiries about things that would have led us to detect the fraud at corporate.” “They’ve been making money for years on the backs of innocent people through deception and fraud.” (TIME asked Alpesh Patel about the charges made by former employees, but he did not answer.)

The Patels rebranded that summer, according to corporate papers, altering the names of many of their pharmacies from “Benzer” to more local-sounding names like “Lemon Bay Drugs” and “Tampa Specialty Pharmacy.” In addition, they renamed “OHM Pharmacy Services” to Ravkoo a few months later. According to four former Patels employees who talked to TIME, using name changes to avoid reputational damage has been part of Patels’ plan for more than a decade.

“The speed with which they were able to get the entire platform up and to operate was alarming,” says Sean Conner, director of Reason and Results, an Austin-based medical litigation support service that shared its Ravkoo research with TIME. “These men set up shop and have been cleaning up after themselves because they knew what they were doing.” It’s something they’ve done before.”

Conner decided to have his team look into its pharmacy partner after hearing an attorney explain a symposium he had attended where the right-wing group America’s Frontline Doctors pushed alternate therapies to COVID-19 immunizations. “It’s astonishing when you look at the vast number of firms they’re running in this,” he says. “Their past lawsuits were for fraud and overpricing, and that’s exactly what they’re doing with ivermectin.”

None of this was visible to the hundreds of thousands of Americans who joined the Ravkoo Pharmacy to fill their prescriptions for experimental COVID-19 treatments. The startup touted itself as a “new digital pharmacy platform” that would connect clients with more than 400 distribution facilities to enable “free same-day prescription delivery to patients’ doorsteps” when it launched in December 2020.

Alpesh Patel seems to be targeting a specific type of customer. He spoke on an internet show sponsored by Jerome Corsi, a right-wing author and prolific conspiracy theorist who had recently launched the “Speak With An MD” telemedicine website. Speak With An MD became a crucial channel through which right-wing political groups poured vaccine-skeptical consumers in search of alternative COVID-19 treatments like hydroxychloroquine and ivermectin, according to Corsi’s far-right connections.

Corsi announced a deal with Ravkoo during the conversation, promising “tremendous” savings to listeners. “By sending medicine to their home,” Patel told Corsi, “we want to make prescriptions convenient for the patient.”

Ravkoo was failing on both counts, according to customers. Patients complained about price gouging, including quotes of up to $600 for ivermectin pills that they said cost a quarter of that at their local pharmacy. One consumer claimed Ravkoo forwarded their prescription to one of Benzer’s pharmacies in Tampa, where they were quoted more than $500 for 80 3-mg pills, which they claimed was at least five times what it should have cost. However, since the Delta version of COVID-19 caused a spike in infections among the unvaccinated, demand for experimental therapies seemed to outweigh customers’ reservations about one of the few companies prepared to fill ivermectin prescriptions.

According to the leaked data revealed by The Intercept, almost all of Ravkoo’s customers paid for these drugs out of pocket. According to patients, the firm solicited clients for their credit card information over the phone and would not take insurance. According to The Intercept’s investigation of hacked data, only $500 of the estimated $8.5 million in sales Ravkoo racked up from ivermectin, azithromycin, hydroxychloroquine, and zinc was paid by insurance carriers.

Jon Matthews, a 37-year-old Minnesota sales professional, says he used AFLD to get ivermectin, which he felt would help him treat his long-haul coronavirus symptoms. Matthews claims that he was able to pay $90 for a prescription recommendation while avoiding a telemedicine appointment with a doctor by completing a questionnaire. Matthews claims that a few days later, someone from Ravkoo in Florida quoted him a $240 pricing for ivermectin and asked for his payment card number over the phone.

Read more: White House Accuses Top Scientist Anthony Fauci Of ‘Playing Politics’

Matthews declined, suspecting it was a ruse. Instead, he dialed the phone number indicated on Ravkoo’s website and waited three hours on hold. He finally got the prescription transferred to his local Walmart, which he claims refused to fill it, after submitting critical feedback on the company’s Facebook page. According to Matthews, “the pharmacist claimed that the quantity they sought [21 mg] was high enough to kill me” based on his bodyweight requirements.

Customers were complaining in late July that Ravkoo was almost completely unresponsive to messages, emails, and phone calls inquiring about the status of their prescriptions. After looking up Ravkoo’s listed address online, which displays a derelict white structure next to a strip mall, some people got dubious. One user posted on the company’s Facebook page, “It’s only a matter of time before they get sued by someone sick or dying.” “Please realize Ravkoo that my family is ill and in need of medication,” one person wrote. “At this time, I have no doubt they have been responsible for deaths.”

Someone from Ravkoo reacted to complaints on the company’s Facebook and BBB pages by asking for patience “in these trying times” in an attempt to stem the onslaught of online questions and negative reviews. The organization has even called customers who have filed complaints with the Better Business Bureau.

Pamela Jean Anderson, who had publicly accused Ravkoo of defrauding her after she never received her prescription, was at her home in Luling, La., dealing with the aftermath of Hurricane Ida when a company official contacted to demand she withdraws the negative review. “We told them this shortly after Hurricane Ida, and all they were concerned about was the negative review making them appear awful,” she says. “I feel like I’ve been duped.”

Medical specialists have also been sounding the alarm. Dr. Jeffrey Aeschlimann, a professor of pharmacy practice at the University of Connecticut, started looking into Ravkoo when a very unwell patient informed him it was where they got the ivermectin they tried to use as a COVID-19 medication rather than seeking medical help. AFLD’s telemedicine service-connected them with a nurse practitioner in New Mexico, then Ravkoo, Aeschlimann discovered that his patient had been prescribed the prescription. The ivermectin prescription was eventually provided in the mail by Tampa Specialty Pharmacy, a Benzer store owned by Ravkoo’s CEO.

“Alpesh Patel’s chain of shady pharmacies and the entire process got ivermectin up to Connecticut for this person’s wrong use,” Aeschlimann adds. “They ended up in the hospital as a result of it.”

Ravkoo’s troubles were getting worse by late summer. First, TIME learned that LegitScript revoked Ravkoo’s certification on Aug. 26, the same day TIME published an investigation into its involvement in AFLD’s fraud. (Ravkoo had marketed this accreditation as “a big milestone” that created “another layer of confidence for both customers and regulators” in the months prior.) Then, on Aug. 30, the Better Business Bureau posted a warning on Ravkoo’s page, citing a pattern of complaints from customers who had not received their prescriptions, we’re unable to contact anybody at the firm through phone, email, or text, and had their refund requests rejected.

In a letter to the BBB on Sept. 2, Ravkoo stated that “because to the COVID Delta Variant rush, our business has surged 10 times,” resulting in the backlog. In addition, the company stated that it was no longer associated with AFLD or Speak With An MD. “In late August 2021, Ravkoo decided to break connections with AFDLS,” a company spokeswoman told TIME in a statement.

It’s unclear how Ravkoo will replace the revenue generated by those companies. But, according to Baney of the Alliance for Safe Online Pharmacies, there’s little stopping them from rebranding again.

“Because the pandemic has drilled into our heads that it’s alright to obtain everything online,” Baney adds, “it’s hard to educate customers on the risk.”

Doctors and pharmacists tell TIME that the pandemic’s relaxation of telemedicine laws has made it difficult for people to identify the difference between reputable services and scammers. Temporary regulatory waivers have been granted to the telehealth industry, allowing patients to continue to receive health care and prescription drugs. In addition, governments at the federal and state levels have relaxed geographic limits and technical requirements, allowing appointments to be made over Facebook or Zoom. Refill and quantity limits for prescriptions were also reduced in many states and insurance providers. Unfortunately, according to industry commentators, this has increased system fraud and abuse.

According to Jason Mehta, a telemedicine fraud attorney in Tampa, the number of alleged fraud cases his firm is processing has nearly quadrupled.

According to Mehta, the change to telemedicine has made it possible for anyone to gain confidence and authority with “little more than polished presentations and slick websites.” “There’s a real chance of having all the components needed to advance these potentially problematic arrangements: unwitting doctors, patients who aren’t always aware, and the rare unscrupulous pharmacy searching for new revenue sources.”

Despite this, Ravkoo has been filling an inflow of prescriptions for experimental COVID-19 treatments for nearly a year with no legal obstacles. As a result, health agencies in the United States, such as the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), as well as major pharmacy organizations, are attempting to educate both consumers and pharmacists by advising against the use of drugs like ivermectin for the treatment of COVID-19.

The American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists issued a statement on Sept. 1 saying they were “calling for an immediate end to the prescribing, dispensing, and use of ivermectin for the prevention and treatment of COVID-19 outside of a clinical trial,” citing the fact that ivermectin prescriptions had increased 24-fold since the pandemic began. In addition, the National Association of Boards of Pharmacy has urged Internet companies to make policy changes to protect patients, such as locking down or suspending domain names used for illegitimate healthcare purposes, as well as flagging or de-indexing known scam sites or those that sell drugs without a prescription.

An FDA representative told TIME that the agency doesn’t comment on possible or existing investigations but that consumers should “avoid online pharmacies that allow people to buy medications without a prescription or by filling out an online questionnaire.” On behalf of Ravkoo, Benzer submitted a job listing on Sept. 26 for an in-house healthcare attorney “with a particular emphasis on regulatory compliance.”

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About Robert Oluoch

My focus is economic, politics, entertainment and gaming reviews. My aim is to depict the complication of life through the combination of words and creativity.

Have a tip we should know? tips@rhd.news

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