Unveiling a Health Care Fraud and Illegal Black-Market Conspiracy
The Department of Justice recently announced the sentencing for a California (CA) pharmacy owner and their co-conspirator for submitting fraudulent claims to Medicare and CA Medicaid for prescription drugs that were never dispensed to beneficiaries.
Investigators from the Federal Bureau of Investigation, the Office of Inspector General and the CA Department of Justice uncovered the fraudulent scheme, in addition to discovering the conspirators were selling drugs on the black market over an eight-month period.
The pharmacy owner was sentenced to two years and three months in prison and their co-conspirator one year and eleven months. The jury convicted both the pharmacy owner and their co-conspirator of one count of conspiracy to commit health care fraud and one count of conspiracy to engage in the unlicensed wholesale distribution of prescription drugs. The co-conspirator was also convicted of an additional three counts of health care fraud.
The pharmacy owners’ co-conspirators created the fraudulent prescriptions based on the owner’s recommended combinations of expensive prescription medications, including HIV drugs. The pharmacy owner would check eligibility of patients for reimbursement, bill the claims to Medicare and Medicaid, but never dispensed them to the patients. Instead, these medications were provided to a co-conspirator (who was not a medical professional) to be sold on the illegal market.
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. Contact PAAS National®® for more information on PAAS’ FWA/HIPAA Compliance Program.
I have a Bachelor of Science degree from the University of Wisconsin-River Falls and have been a Certified Pharmacy Technician since 2001. Prior to joining the PAAS team, I was a floating technician, 3rd party district chargeback specialist, and district pharmacy training coordinator. Formerly, I was also an instructor for pharmacy technician certification classes.
PAAS’ personal, one-on-one connection will help your pharmacy become more successful in dealing with tiresome PBM audits. It is a pleasure knowing that my colleagues and I can help member pharmacies.
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