Pulling Fraud Off the Streets

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38073417 - pharmacist presenting medications on his hand in the pharmacy

Statistics from the National Institute on Drug Abuse show that the abuse of prescription opioids costs our Nation $26 billion in health care-related expenses each year. Another $78.5 billion in costs can be attributed to crime, lost work productivity and health care. A Detroit-area pharmacist contributed to those staggering statistics by taking advantage of Medicaid when he submitted illegal bills related to dealing black market pain pills.

The pharmacist, who operated two pharmacies, fraudulently billed Medicaid $1.6 million for controlled substance prescriptions presented by “runners.” (They often presented as many as 25 prescriptions at a time for Medicaid beneficiaries who supposedly needed the drugs.)

Over about a year, the pharmacist filled approximately 222,000 doses of controlled drugs like Oxycontin, Oxycodone, and Hydrocodone ,all addictive and deadly opioids, if used incorrectly. To prevent the scam from being detected, the pharmacist tried to maintain a 70 to 30 percent ratio of non-controlled drug prescriptions to controlled drug prescriptions.

The 56-year-old fraudster pleaded guilty to illegal prescription drug distribution, health care fraud and money laundering. (He once laundered $150,000 in a single transaction.) He was sentenced to four years and four months in federal prison and agreed to forfeit $1.4 million seized from his bank accounts.

This man was just one of 44 people implicated in a much larger medical crime network that targeted Medicaid with $122 million in fraudulent claims. The network included doctors, pharmacists, social workers and physical therapists. (Apparently, it takes a village to commit fraud of this magnitude.) Congratulations to the investigative team who prevented this pharmacist from diverting prescription drugs to the streets, undoubtedly saving many lives from inappropriate prescription drug use.

Source: Today’s “Fraud of the Day” is based on an article entitled, “Pharmacist heads to prison for role in $122 million Medicaid fraud network,” posted on mlive.com on May 4, 2017.

A Detroit-area pharmacist accused of defrauding Medicaid in a scheme centering on illegal billing and dealing black market pain pills has been sentenced to four years and four months in federal prison.

Nadeem Iqbal, 56, of Rochester Hills, also agreed to forfeit $1.4 seized from his bank accounts.

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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.