Two Men Accused of $120M Medicare and Medicaid Fraud Using Vulnerable Adults

Last month, PAAS National® wrote about the record-setting $6.8 billion in False Claims Act recoveries in fiscal year 2025. With a continued and expanding focus on fraud enforcement, and strong recoveries in the health care and life sciences, expect an increase in cases the Department of Justice is investigating. In a recent case, two individuals from Queens, NY, were charged with defrauding Medicare and Medicaid by paying illegal kickbacks and bribes, and submitting claims for services that were never provided.

From 2016 to 2026, the two defendants used a pharmacy and two social adult day care centers, meant to help senior citizens, to fraudulently bill Medicare and Medicaid $120 million. The fraud started by luring Medicare patients with illegal cash payments and supermarket gift cards to induce them to fill prescriptions at the defendants’ pharmacy. The same type of illegal cash kickbacks were paid to Medicaid patients to enroll in the social adult day cares owned by the same men. The claims submitted to Medicaid for the day care services often exceeded the permitted capacity of the facilities. 

Some of the healthcare fraud cases PAAS summarizes in our Newsline articles are brazen, extreme cases, but they can also serve as a good reminder to review how you are conducting business. For example, most pharmacies are not giving cash and gift cards to patients for filling prescriptions at their pharmacy, but routinely waiving copays can be another form of an illegal inducement under Anti-Kickback Statutes (and Civil Monetary Penalties Law) and implicate FCA violations. 

PAAS Tips:

Erin McDonald, PharmD
Latest posts by Erin McDonald, PharmD (see all)