Havertown Doc Admits To Bogus Healthcare Billing To Pocket $1.1M

HAVERTOWN, PA — A doctor who practiced in Havertown and two other locations recently agreed to settle on allegations he fraudulently billed health insurance programs for medications he did not use to benefit himself financially.

United States Attorney William M. McSwain said Thomas J. Whalen, D.O., 65, of Berwyn, agreed to pay the $1,257,499.00 to resolve allegations under the False Claims Act that he submitted or caused the submission of false claims to federal health care plans for FDA-approved versions of Remicade, Orencia, Prolia/Xgeva, Synvisc/Synvisc One, and Boniva when he had, in fact, administered non-FDA-approved, foreign versions of these medications.

Whalen also admitted to knowingly and intentionally prescribing controlled substances outside the usual course of professional practice and without a legitimate medical purpose.

He permanently surrendered his controlled substance registrations with the DEA, surrendered his medical license, and will be excluded from participation in federal programs.

Whalen owned and operated Rheumatology Consultants, P.C., doing business as Whalen Rheumatology Group, with locations in Havertown, Exton, and Wilmington, Delaware.

As part of his practice, Whalen used medications administrated by injection and infusion to treat his patients. These medications — including Remicade Synvisc, Synvisc-One, Orencia, Prolia/Xgeva, and Boniva — are made of living cells and are expensive.

Rather than purchase FDA-approved versions of these medicines from authorized distributors, Whalen devised a scheme to purchase much cheaper foreign, non-FDA-approved versions of these medications. Unbeknownst to his patients, Whalen injected or infused them with the non-FDA-approved medications and then billed health care programs as if he had used the approved medications and pocketed approximately $1.1 million in illicit gains.

Whalen also prescribed oxycodone to patients abusing drugs. He admitted to unlawful distribution of a controlled substance to two of his patients he prescribed oxycodone to even after seeing drug tests for each that showed the patients simultaneously abused cocaine and heroin.

In December 2019, Whalen also pleaded guilty to related criminal charges of one count of health care fraud, one count of importation contrary to law, and two counts of distributing and dispensing oxycodone outside the course of professional practice and not for a legitimate medical purpose. He was sentenced this week to one day incarceration, followed by 12 months home confinement, three years supervised release and a $25,000 fine.