How an Online Pharmacy Sold Millions Worth of Dubious COVID-19 Drugs — While Patients Paid the Price

Before the COVID-19 pandemic, the network of pharmacies run by businessmen Alpesh and Manish Patel was struggling.

At least 15 of its 82 pharmacies had been shuttered or sold amid mounting debts and mismanagement. It faced lawsuits alleging it owed millions of dollars to pharmaceutical suppliers and shipping companies. Employees and patients had started to accuse the company of fraud. Some employees who had left were being questioned by federal law enforcement agents. One top executive had previously been convicted for his role in running a national opioid pill mill; another was barred from doing business with federal health-care programs due to allegations ranging from conspiracy to paying illegal kickbacks.

But then the pandemic presented an opportunity: loosened rules for telehealth and long-distance prescription writing combined with massive demand for unproven COVID-19 treatments could mean big money. And the Patels soon capitalized.

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

Then, in Oct. 2020, the Patels quietly filed a name change for one of their troubled pharmacy companies in Auburndale, Fla., distancing it from a previous multi-million dollar settlement for filling fraudulent prescriptions. The newly rebranded digital pharmacy was named Ravkoo. And with the help of a $173,733 PPP loan, it would soon become a key player in a booming industry that fills telemedicine prescriptions for bogus COVID-19 treatments like ivermectin and hydroxychloroquine through a partnership with America’s Frontline Doctors (AFLD), a controversial right-wing political group.

From Nov. 2020 to Sept. 2021, Ravkoo filled at least 340,000 prescriptions, amounting to an estimated $8.5 million in drug costs, according to recently hacked data published by The Intercept. Nearly half the prescriptions were for ivermectin or hydroxychloroquine, according to the hacked data; another 30% were for zinc or azithromycin, two other medications which health authorities say are also ineffective in treating or preventing COVID-19 but which anti-vaccine groups have been promoting.

Ravkoo often charged patients exorbitant prices for these COVID-19 “wonder drugs.” With the company overwhelmed by demand, hundreds of patients were left in the lurch, according to hundreds of messages in anti-vaccine Telegram and Facebook groups reviewed by TIME. Sometimes the medication never arrived. Many people reported desperately trying to reach Ravkoo as they or their family members grew sicker waiting for the medication rather than going to a doctor. “I called, emailed, texted Ravkoo over a dozen times with zero help,” one customer wrote on their Facebook page Aug. 18. Others who had already paid $90 for a telemedicine consultation couldn’t afford the prices Ravkoo charged for ivermectin, leading them to resort to a version of the anti-parasitic drug intended to deworm horses, according to the social media posts.

The story of how Ravkoo reinvented itself as an ivermectin supplier reveals how the telemedicine boom, accelerated by the pandemic, has left patients vulnerable. U.S. health officials have warned for more than a year that “rogue online pharmacies” could seize on misinformation and medical distrust to peddle unproven and potentially dangerous prescription drugs to treat COVID-19. Yet a TIME investigation, based on public records and more than two dozen interviews with former employees, customers, pharmacists, and law enforcement officials, shows how easy it was for a company whose owners have a record of legal challenges to secure taxpayer funds to prop up a business distributing dubious drugs to misinformed patients.

Read More: How America’s Frontline Doctors Sold Access to Bogus COVID-19 Treatments—And Left Patients in the Lurch

So far there appear to have been few consequences. Ravkoo has been on a hiring spree, and has hired a Washington consulting firm that specializes in corporate reputation management. It’s now working with a staffing agency to keep up with spiking demand for prescriptions, according to a response it filed to complaints submitted to the Better Business Bureau (BBB). While U.S. agencies say they have been cracking down on questionable digital pharmacies during the pandemic, neither Ravkoo nor its parent company have been a recipient of any publicly posted warning letters so far.

“Ravkoo seeks to help advance the health of patients and is committed to a compliance program that is consistent with industry standards,” a spokesperson said in a statement to TIME. Alpesh Patel, Ravkoo’s CEO, did not respond to repeated requests for comment over the course of six weeks, and the company declined to respond to questions about its business model, lawsuits and investigations into the company, as well as detailed allegations of fraud by former employees.

Libby Baney, a senior adviser to the nonprofit Alliance for Safe Online Pharmacies, says the case of Ravkoo is a cautionary tale for a burgeoning industry. In a report last year, the group found there were more than 35,000 online pharmacies active worldwide, 96% of which were operating in violation of state or federal law and relevant pharmacy practice standards. The report found that 100% of online searches to buy medicine return links for illegal pharmacies. Some providers sell medicine without a prescription; others operate without a license or peddle bogus drugs.

“Click here, chat with a doctor in some jurisdiction, get a prescription. Maybe it gets dispensed to you from some source, maybe it doesn’t,” says Baney. “That kind of business model can really confuse patients and ultimately cause harm.”

Five years ago, Alpesh Patel, then 34, was promoting himself as the portrait of an American success story. He was on a media tour to tout a company called Benzer Pharmacy as a chain of independent stores that collectively could compete with industry giants. “That’s why Benzer exists,” Patel said in a 2016 interview. “To provide the mom-and-pop pharmacy with the resources they need… to put them back on a level playing field with the large-scale chains.”

In a round of interviews in 2016, the Florida-based CEO recounted coming to the U.S. from India a decade earlier to join his wife, a U.S. citizen. Holding a degree from a pharmacy college in Gujarat, he worked as a delivery driver until he became a licensed pharmacist in Michigan. Patel soon got a job at Walgreens, but said he did not like the culture of large corporate pharmacies. So in 2009, he partnered with Manish Patel to open the first of their own independent pharmacies in Flint, Mich.

Alpesh Patel had ambitious plans. “We are going to lots of baby boomers who opened their pharmacies 30, 40 years ago and now they’re getting ready to retire, so we’re acquiring their stores,” he told the Tampa Business Journal, saying that Benzer was purchasing up to four pharmacies a month and planned to grow to 600 stores. In 2017, Patel was named one of the Tampa Bay area’s “40 under 40,” in a piece that detailed how he had grown the company’s annual revenue to $234 million.

But this shiny veneer was not the whole story. While Patel was the face of the company, many of its top executives had faced criminal charges.

Manish Patel, Benzer’s president, had been prosecuted in 2008 in a Michigan district court for allegedly conspiring to run a wide-scale prescription drug mill to defraud Medicare and Medicaid. (The charges were later dismissed.) Vinesh Darji, the president of Benzer’s franchising division, had been convicted by a federal jury in Ohio in 2012 for illegally dispensing opioids as part of a drug conspiracy that authorities said sent millions of dollars worth of addictive prescription painkillers to all 50 states.

In 2017, Benzer’s head of human resources, Cordera Hill, was sentenced to 24 months in federal prison after being found guilty of conspiracy and paying illegal kickbacks in a scheme to defraud Tricare, the insurance program for U.S. military, veterans and their families. Hill was put on the Department of Health and Human Services’ “exclusions list” of individuals barred from doing business with federal health-care programs because they “pose unacceptable risks to patient safety and/or program fraud.”

Two Benzer pharmacies agreed to pay the federal government $750,000 in 2016 to resolve claims that they had been fraudulently billing Medicare and Medicaid for prescription medications by dispensing cheaper generic drugs instead and pocketing the difference. The year before that, OHM Pharmacy—the company that was later rebranded as Ravkoo—paid the federal government a settlement of $4.1 million for fraudulently billing Tricare, according to the Department of Justice.

Yet despite this record, the Patels were able to build a constellation of up to 160 health companies and pharmacies, according to data compiled by Reason and Results, the medical litigation support firm. One former prosecutor, who worked on the OHM case, likened chasing the Patels to a game of whack-a-mole. “It was an orchestrated effort to move from one pharmaceutical scheme to the next,” says the former prosecutor, who asked not to be identified because he still works in the industry.

By 2020, Benzer boasted it had 82 locations and 650 employees. Yet many of the pharmacies it acquired were struggling. Online reviews complained of frequent supply issues and high prices. At a local pharmacy acquired by Benzer in Yellow Springs, Ohio, things got so bad that the manager and another pharmacist quit after being unable to provide longtime patients their prescriptions. People who self-identified as employees at Benzer’s corporate offices in Tampa posted reviews of the company on public sites that complained of fast turnover, bounced checks, and a worrying lack of transparency. “They scam people daily,” one employee complained in Nov. 2019. Another former employee accused the Patels of “shady side businesses, mismanagement of funds, and defrauding the health system,” in a review of Benzer on the jobs site Indeed.

Two former corporate employees who spoke to TIME described a company obsessed with its external image, which pushed employees to leave positive online reviews. The company’s human resources department seemed to frequently delete files and documents about its operations, they said, and barred staffers from talking to local pharmacy owners who called for help. “This organization is all about optics,” one former employee says. “They are focused on making it look good from the outside.” The employees also told TIME they believed the company did not pay their healthcare benefits with the money withheld from paychecks.

Chris Lenz, a former regional manager, said corporate mismanagement of the 11 pharmacies he oversaw in Ohio took a human toll. “Real lives of local medical professionals are being torn apart and careers ruined because of the association with Benzer [and] Alpesh and Manny’s practices,” Lenz says.

In early 2020, Benzer fired all its regional managers and sold or closed 15 of its 82 stores, according to former employees. Lenz believes this was in part “because we started individually asking questions about things that would have led us to discovering the fraud at corporate,” he says. “They’ve been making their money through fraud [and] deceit for years at the expense of innocent people.” (Alpesh Patel did not respond to questions from TIME about the allegations made by former employees.)

That summer, corporate filings show that the Patels rebranded, changing many of their pharmacies’ names from “Benzer” to more local-sounding names, like “Lemon Bay Drugs North” and “Tampa Speciality Pharmacy.” A few months later, they changed “OHM Pharmacy Services” to Ravkoo. Using name changes to escape reputational damage has been part of the Patels’ playbook for more than a decade, according to four former employees who spoke to TIME.

“The speed at which they were able to get the whole platform up and running was disconcerting,” says Sean Conner, the director of Reason and Results, the Austin-based medical litigation support firm which shared its research on Ravkoo’s business with TIME. “These guys set up shop and they’ve just been cleaning house, because they knew how to do it. They’ve done it before.”

After hearing an attorney discuss a summit he had attended in which the right-wing group America’s Frontline Doctors touted alternative treatments to COVID-19 vaccines, Conner decided to have his team look into its pharmacy partner. “When you look at the long list of companies that they are running in this, it’s unbelievable,” he says. “Their previous lawsuits were literally for fraud and overpricing, which is exactly what they’re doing with ivermectin.”

None of this was visible to the hundreds of thousands of Americans who signed up to have their prescriptions for unproven COVID-19 treatments filled by the brand-new Ravkoo Pharmacy. Launched in Dec. 2020, the company billed itself as a “revolutionary digital pharmacy platform” that would connect customers with more than 400 distribution centers to provide “free same-day prescription delivery to patients’ doorsteps.”

Alpesh Patel appeared to have a specific kind of customer in mind. In April, he went on an online show hosted by Jerome Corsi, a right-wing author and prolific conspiracy theorist, who had recently set up a telemedicine website, “Speak With An MD.” Drawing on Corsi’s far-right connections, Speak With An MD became a key portal through which right-wing political groups funneled vaccine-skeptical customers in search of alternative COVID-19 treatments like hydroxychloroquine and ivermectin.

In the interview, Corsi announced a partnership with Ravkoo, which he promised would give listeners “tremendous” savings. “We want to make prescriptions convenient for the patient,” Patel told Corsi, “by sending medicine to their doorstep.”

According to customers, Ravkoo was failing on both counts. Patients posted complaints of price gouging, citing quotes of up to $600 for doses of ivermectin that they said cost one-fifth of that price at their local pharmacies. One customer said Ravkoo sent their prescription to one of Benzer’s pharmacies in Tampa, who quoted them more than $500 for 80 3-mg pills—at least five times what it should cost, they said. But as the Delta variant of COVID-19 led to a surge in infections among unvaccinated Americans, demand for unproven treatments seemed to override customers’ concerns about one of the only companies willing to fill ivermectin prescriptions for them.

Almost all of Ravkoo’s customers paid for these medications out of pocket, according to the hacked data published in The Intercept. The company called customers over the phone for their credit-card information and did not accept insurance, according to patients. Of the estimated $8.5 million in sales Ravkoo racked up from ivermectin, azithromycin, hydroxychloroquine and zinc, only $500 was paid by insurance providers, according to The Intercept‘s analysis of hacked data.

Read More: Will Doctors Who Are Spreading COVID-19 Misinformation Ever Face Penalty?

Jon Matthews, a 37-year-old sales representative in Minnesota, says he went through AFLD to acquire ivermectin, which he thought could help treat his long-haul coronavirus symptoms. Matthews says he filled out a questionnaire that allowed him to pay $90 for a prescription referral while bypassing the telehealth visit with a physician. A few days later, Matthews says, someone affiliated with Ravkoo in Florida simply cited him a price of $240 for ivermectin and asked for his credit card number over the phone.

Thinking it might be a scam, Matthews declined. He called the number listed on Ravkoo’s website, and waited on hold for three hours. After leaving negative feedback on the company’s Facebook page, he finally succeeded in getting the prescription transferred to his local Walmart, which he says refused to fill it. “The pharmacist said that the dosage they requested [21 mg] was high enough to kill me” based on guidelines for his body weight, Matthews told TIME.

By late July, customers were posting complaints that Ravkoo was almost completely unresponsive to texts, emails and phone calls demanding to know where their prescriptions were. Some became suspicious after searching Ravkoo’s listed address online, which only shows a dilapidated white structure by a strip mall. “It’s just a matter of time before they get sued by someone sick or dying,” one person wrote on the company’s Facebook page. “Ravkoo please understand my family is very ill and in need of medication,” wrote another. “Truly I have no doubt they have been responsible for deaths at this point.”

Trying to stem the avalanche of online questions and negative reviews, someone at Ravkoo responded to complaints on the company’s Facebook and the BBB pages by asking for patience “in these difficult times.” The company has even gone as far as calling customers who reported them to the BBB.

Pamela Jean Anderson, who had publicly alleged being scammed by Ravkoo after she never received her prescription, was dealing with the aftermath of Hurricane Ida at her home in Luling, La., when a company representative called to demand she retract the negative review. “They called right after Hurricane Ida and we told them this, and all they were worried about was the negative review made them look bad,” she says. “I feel completely scammed.”

Medical professionals have been raising alarms too. Dr. Jeffrey Aeschlimann, a professor of pharmacy practice at the University of Connecticut, began to look into Ravkoo after a severely ill patient told him it was where they had obtained the ivermectin they had tried to use as a COVID-19 treatment instead of seeking medical care. Aeschlimann discovered that his patient had been prescribed the drug through AFLD’s telehealth service, which connected them with a nurse practitioner in New Mexico, then Ravkoo. Tampa Specialty Pharmacy, a Benzer store owned by Ravkoo’s CEO, ultimately sent the ivermectin prescription through the mail.

“Alpesh Patel’s web of deceitful pharmacies and that whole process somehow got ivermectin up to Connecticut for this person’s misguided use,” Aeschlimann says. “And it landed them in the hospital.”

By late summer, Ravkoo’s problems were mounting. LegitScript, which provides third-party certification of health-care companies, told TIME it revoked Ravkoo’s certification on Aug. 26, the same day TIME published an investigation detailing its involvement in AFLD’s scheme. (Ravkoo had heavily promoted this certification in the preceding months as “a major milestone” that added “another layer of trust for both customers and regulators.”) The BBB placed a warning on Ravkoo’s page on Aug. 30, noting a pattern of complaints from customers who were not receiving their prescriptions, could not reach anyone at the company via phone, email or text, and had their requests for refunds ignored.

On Sept. 2, Ravkoo said in a response to the BBB that “due to COVID Delta Variant surge our business has increased 10 times,” creating the backlog. The company also said it was no longer affiliated with AFLD and Speak With An MD. “Ravkoo made a decision to cut ties with AFDLS in late August 2021,” a company spokesman told TIME in a statement.

It’s not clear how Ravkoo will replace the business those groups brought in. But there’s little stopping them from rebranding once again, says Baney of the Alliance for Safe Online Pharmacies.

“We’re so used to buying things on the Internet right now that it’s hard to educate consumers on the risk,” Baney says, “because the pandemic has pounded into our heads that it’s okay to get everything online.”

Doctors and pharmacists tell TIME that the loosening of telemedicine regulations prompted by the pandemic has made it difficult for some to distinguish legitimate businesses from scam artists. The telehealth industry was granted temporary regulatory waivers to allow patients to continue to access health care and prescription medications. Federal and state governments lifted geographic restrictions and technology requirements to allow for appointments through Facebook or Zoom. Many states and insurance companies also relaxed prescription requirements for refills or quantity limits. The result has been a rise in fraud and abuse of the system, industry analysts say.

Jason Mehta, a Tampa-based attorney who specializes in telemedicine fraud, says the number of alleged fraud cases his firm is handling has almost quadrupled.

The shift to telemedicine has allowed anyone to build trust and credibility with “nothing more than polished presentations and slick websites,” Mehta says. “There’s the real possibility of having all the ingredients necessary to further these potentially problematic arrangements: unwitting doctors, patients who are sometimes none the wiser, and occasional unscrupulous pharmacies looking for new revenue sources.”

Yet no legal barriers have prevented Ravkoo from filling an influx of prescriptions for unproven COVID-19 treatments for nearly a year. This has left U.S. health agencies like the CDC and the FDA, as well as major pharmacy groups, trying to educate both consumers and pharmacists by warning against the use of drugs like ivermectin for treating COVID-19.

On Sept. 1, the American Medical Association, American Pharmacists Association, and American Society of Health-System Pharmacists said 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,” noting that ivermectin prescriptions had increased 24-fold since before the pandemic began. The National Association of Boards of Pharmacy has called on Internet companies to implement policy changes for patient safety, including locking down or suspending domain names being used for illegitimate healthcare purposes and flagging or de-indexing known scam sites or those that offer drugs without a prescription.

An FDA spokesman told TIME the agency does not discuss potential or ongoing investigations, but noted that it is advising consumers “to avoid online pharmacies that allow them to buy drugs without a prescription or by completing an online questionnaire.” On Sept. 26, Benzer posted a job listing for an in-house healthcare attorney on behalf of Ravkoo “with particular emphasis on regulatory compliance.”

With reporting by Alejandro de la Garza, Simmone Shah and Julia Zorthian

Correction, Oct. 18: The original version of this story misstated the relationship between Alpesh and Manish Patel. They are business partners, but not relatives. The original version of this story also misstated the same Manish Patel’s status on the HHS OIG exclusions list. A different person with the same name is on the list; the Manish Patel discussed in this story is not. This story has also been updated to reflect that the 2008 charges against Manish Patel were later dismissed.