Double Billing

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Government investigations and prosecutions involving pharmacies around the country are on the rise, due to an increase in fraudulent Medicare billing schemes. One common tactic for bilking the government healthcare benefits program includes billing for and dispensing large numbers of painkillers and other controlled substances or costly brand name drugs instead of generics that were available and should have been dispensed. But, we all know fraudsters are a creative lot, churning out new scams all the time. A press release from the Department of Justice describes the actions of one pharmacist who used another method to steal money from the government. She directed a scheme to repackage and redistribute prescriptions that had already been billed to Medicare once. (An interesting spin on reduce, reuse, recycle?)

The press release states that over a five-year period, the pharmacist owned and operated an independent pharmacy in Baton Rouge. The 47-year-old woman paid nursing homes and mental health facilities to collect and return unused prescription medications to the pharmacy. The pharmacist then directed her employees to re-package them and re-distribute through other prescriptions while essentially billing Medicare again for the same medication. Her actions caused more than $2.2 million in fraudulent billings. (Not exactly chump change.)

The pharmacy owner pleaded guilty to one count of health care fraud. Sentencing is scheduled for a later date.

Fraudulent activity can often be tied back to independent pharmacies, such as the one in this case, as opposed to chain drug stores nationwide because independent pharmacies tendency to provide more service to local nursing homes, hospice and other extremely ill Medicare patients who use a higher quantity of expensive drugs. Thanks to the efforts of the Medicare Strike Force, this fraudster has been stopped from taking additional benefits she does not deserve. (Let’s hope that her punishment will fit the crime.)

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Owner of Baton Rouge Pharmacy Pleads Guilty for Directing $2.2 Million Health Care Fraud Scheme,” released by the Department of Justice on April 24, 2014.

The owner of a Louisiana pharmacy pleaded guilty today for directing a $2.2 million Medicare fraud scheme to repackage and redistribute prescription medications.

Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, Interim U.S. Attorney J. Walter Green of the Middle District of Louisiana, Special Agent in Charge Mike Fields of the Dallas Region of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division and Louisiana State Attorney General James Buddy Caldwell made the announcement.

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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.