In the heart of Manhattan’s Financial District


In the heart of Manhattan’s Financial District

5 examples of pharmacy fraud

On Behalf of | Apr 25, 2018 | White Collar Crimes |

Fraud occurs in every sector of the health care industry. Pharmacists and pharmacy technicians may participate in fraudulent behavior. Owners and employees of pharmacies may face criminal consequences for committing a fraudulent scheme.

But how do pharmacists and technicians commit fraud? These are some common types of pharmacy fraud.

1. Drug diversion

Prescription drugs are highly sought after, and abuse of prescription medications is a serious problem. Because a lot of people desire to use prescription drugs illegally, pharmacists may take drugs out of official circulation and sell them on the streets. Pharmacists may accomplish this by dispensing a few prescriptions short by a few pills here and there, slowly building up enough pills to sell.

2. Benefiting from bribery

Some pharmacists may give money to doctors in exchange for exclusive referrals and recommendations. Certain pharmacies may also commit bribery by giving gift cards to patients so they switch their prescriptions over. The term for this type of crime is a “kickback.”

3. Automatic refills

It surprises some patients to find out their prescriptions are filled even when they do not request refills. This happens when pharmacies partake in an auto-refill scheme. After refilling the prescriptions, the pharmacy bills Medicare for medications that do not get picked up.

4. Switching drugs

As the term suggests, this type of fraud occurs when a pharmacy fills a prescription with a different medication. A pharmacist switching a capsule Medicaid or Medicare prescription to a tablet may count as stealing from the government.

5. Billing schemes

There are many different types of fraudulent billing practices:

● Billing for a nonexistent or false prescription

● Billing for a brand name medication when dispensing a generic drug

● Billing multiple payers for one prescription

These are just a few types of fraud that pharmacies may commit. Allegations of fraud are serious for any pharmacy organization or individual pharmacist.


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