Pharmacist Sentenced to 80 Months in Prison

According to a press release from the Department of Justice (DOJ), a Michigan pharmacist was sentenced to 80 months in prison for committing health care fraud. The pharmacist’s scheme consisted of billing health care benefit programs for prescription medications that were ultimately never dispensed. From 2019 through 2022, the pharmacist and his co-conspirator used forged prescriptions from providers to conceal their fraudulent scheme; however, there was no record of these patients ever seeing the prescribers indicated on the forged prescriptions.

Together, these two perpetrators caused over $6 million in losses to health care benefit programs like Medicare, Medicaid, and Blue Cross Blue Shield of Michigan. The pharmacist pleaded guilty to one count of conspiracy to commit health care fraud. In addition to being sentenced 80 months in prison, the pharmacist was ordered to pay $3,889,760 in restitution and $3,230,147 in forfeiture, including his interest in approximately $1.2 million of fraudulent proceeds seized by law enforcement.

PAAS Tips:

  • Only bill a claim pursuant to a valid prescription on file. Billing a “test” claim or “ghost” claim is prohibited by PBMs and those claims, even if reversed, are still subject to audit.
    • Failure to provide a valid hardcopy can raise red flags and lead to accusations of billing false claims
  • For more examples of fraud, waste and abuse, please see our October 2025 Newsline article, Real-World Examples of Fraud, Waste & Abuse and Audit Implications
Heaven Bennett, CPhT
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