License to Steal

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Licenses are generally required to either practice in a particular employment field or to operate something. (For example, you cannot drive an automobile without first passing the driving test and proving that you can safely operate a vehicle. If you are a building contractor, no one would want you to construct their new house without proving you have a license indicating you know your trade.) An article posted on mlive.com tells about a man who was licensed as a pharmacist. Instead of using his license to fill legitimate prescriptions, he used it to steal more than $3 million from Medicare, Medicaid and other private insurers.

The story states that this particular pharmacist and 38 others participated in the health care fraud scheme. (Fraudsters rarely act alone.) For more than a year, this fraudster worked as a pharmacist in one of his co-defendants’ apothecaries located in eastern Michigan. In that capacity, he assisted with the illegal distribution of controlled substances.

The scam, which was spearheaded by the pharmacy owner, involved paying kickbacks and other forms of illegal payments to physicians in exchange for writing prescriptions for expensive medications that were unnecessary or not needed. The prescriptions for controlled substances would then be billed to Medicare, Medicaid or to private insurers through the chain of pharmacies. (Apparently, the pharmacist took part in illegally distributing 245,000 doses of narcotics, anxiety medication and codeine-laced cough syrup. But, in many instances, the prescriptions were never dispensed nor distributed to patients.)

The 52-year-old pharmacist pleaded guilty to conspiracy to commit health care fraud and conspiracy to distribute a controlled substance. He was sentenced to serve 27 months in prison. (His sentence was relatively short compared to the pharmacy chain owner who was ordered to serve 17 years in prison for masterminding the scheme.)

The article explains that the pharmacist received a reduced prison sentence because he testified against others who were also involved in the scheme. (It’s a smart idea to confess your crime and assist prosecutors as much as possible.) The state also gets a standing ovation for suspending the pharmacist’s license to practice because of his integral role in the scam. We do not know whether or not the license suspension is temporary or permanent; however, one thing’s for sure – his license to conduct life as usual has been revoked in the near term.

 

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Pharmacist’s License Suspended for Role in $3 Million Fraud,” written by Gary Ridley and posted on mlive.com on September 15, 2015.

GRAND BLANC, MI — The state has suspended the license of a Grand Blanc pharmacist for his role in a health care fraud scheme that cost the government millions.

The state announced Tuesday, Sept. 15, that it issued an August order summarily suspending the license of Pradeep Natvarlal Pandya following his June 2015 federal court felony convictions in U.S. District Court in Detroit.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.