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.