Nine Pharmacists Charged in $12 Million Fraud Related to Invoice Shortages

Nine pharmacists were recently indicted on felony charges in a $12.1 million health care fraud scheme according to a June 17, 2020 U.S. Department of Justice press release. The licensed pharmacists and pharmacy owners in Detroit and southern Ohio are alleged to have billed Medicare, Medicaid and Blue Cross Blue Shield for medications that were neither purchased nor dispensed, resulting in invoice shortages. Additionally, they are alleged to have provided kickbacks to prescribers, waived patient copays and billed claims for medications purportedly dispensed to beneficiaries after their death.

Headlines like these are the fuel that PBMs use to ramp up invoice audits. While these examples represent a very small minority of pharmacists, they tarnish the reputation of independent pharmacies nationwide.

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Review your purchasing, billing and documentation procedures to ensure that you are prepared should the inevitable invoice audit happen at your pharmacy
Consider performing a mock audit as discussed in the January 2020 article Self-Audit Series #12: Invoice Audit to identify any discrepancies now which will provide your pharmacy the opportunity to fix the problem prior to an official audit
Notify PAAS immediately of any invoice audit so that we can help guide you through a comprehensive response

Author
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Eric Hartkopf, PharmD

Analyst at PAAS National^®

As an Analyst, I focus on providing pre- and post-audit assistance, answering various member service questions, and researching & drafting articles for the Third-Party Newsline. I work with many of our members involved with invoice audits.

I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.

I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.

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