The arrest of two New York pharmacists following a 2017 federal government sting operation turned a spotlight on people who use their professional capacity to commit fraud against insurers.
The pharmacists’ activities, which continued for nearly three years, reportedly netted them over $3 million in insurance company reimbursements for medications they never dispensed.
Working on a tip they received from a Medicaid management care group, undercover agents from the Medicaid Fraud Control Unit, which operates out of the New York Attorney General’s Office, conducted undercover investigations at three New York City pharmacies. The agents posed as Medicaid patients, and the supervising pharmacist allegedly paid them cash for HIV prescriptions as well as for referring other patients.
Profits from auto-filling
The pharmacists were engaged in “auto-filling,” whereby they submitted false claims to insurers that included Medicaid for prescription refills they never provided to customers. Their indictment reveals that between January 2014 and August 2017, they billed these insurers over $11 million for the medications they supposedly needed to fill prescriptions, but they only purchased a fraction of the medications required.
Facing stiff penalties
The two pharmacists face a long list of charges that included Grand Larceny in the First Degree, Grand Larceny in the Second Degree, Scheme to Defraud in the First Degree, Offering a False Instrument for Filing in the First Degree and various others. The owner of the pharmacies faces up to 25 years in state prison; the supervising pharmacist faces up to 15 years.
Allegations of Medicare fraud can be made against physicians, medical clinics and even patients themselves. Pharmacists are particularly vulnerable: Federal authorities frequently make unannounced calls at pharmacies to ensure that both owners and staff are complying with regulations, which often change. Those who find that they are under investigation for allegedly fraudulent activities should reach out for legal assistance without delay.