Pharmacy Owner’s Involvement in Fraud Scheme Leads to 4-Year Prison Sentence

The Department of Justice recently announced the sentencing for a New York pharmacy owner. A four-year prison term, three years extended supervision, and paying back restitution of more than $6 million dollars, is the outcome for this owner based on his involvement in a Medicare and Medicaid fraud scheme.

Investigators from the Federal Bureau of Investigation, the Office of Inspector General, and the U.S. Department of Health and Human Services discovered Medicare, Medicaid, and private insurance companies paid approximately $5.2 million dollars in fraudulent HIV claims to this pharmacy from 2021 to 2022.

The pharmacy owner was paying illegal kickbacks to low-income HIV patients if they would fill their expensive medications at his pharmacy. Part of this scheme was to repurchase (back from the patients), the unopened bottles of the expensive medications at a fraction of their actual value. These medications would then be “re-used” over and over, while never actually being dispensed to the patients.

The investigation also discovered the pharmacy owner was unlawfully selling pharmaceuticals to other pharmacies that had been obtained from illegal sources.

Ensure your pharmacy has a robust Fraud, Waste and Abuse Compliance Program in place for employees to understand the repercussions of violating laws and regulations such as the False Claims Act and the Anti-Kickback laws. Contact PAAS National®® (608) 873-1342 for more information on PAAS’ FWA/HIPAA Compliance Program that is easy to set-up, web based and customized for your pharmacy.

Dana Westberg, CPhT