Fanny Pack Fraud

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49329675 - woman gives parcel in post office

In spite of the funny name, fanny packs are very useful to have. They can be used to tote around a variety of items including keys, a wallet, a cell phone and, according to an article on ProRepublica.com, a stack of bogus prescriptions linked to a massive Medicare fraud scheme. (Now that’s something you don’t see every day.)

According to the article, a kidney specialist in Key Biscayne had an incredibly large surge in Medicare Part D prescriptions. In fact, they increased from $282,000 in 2010 to $4 million in 2011. The following year, the prescriptions rose to an incredible $5 million. (Wow, that’s quite a jump!) Ironically, it wasn’t Medicare that recognized the huge increase, but the doctor herself. The scam was discovered when the doctor asked the secretary to mail a fanny pack to her brother. But, there was a mix up, and instead of the fanny pack, he received a package of fabricated prescriptions allegedly signed by his sister. She knew something was amiss and reported it to the authorities. (Kudos to the doc for being honest.) A subsequent investigation discovered numerous related scams that collectively cost the government $7 million.

It turns out that the secretary for the kidney doctor’s office would use the physician’s paper prescriptions to create fraudulent scripts for Medicare patients. She allegedly was paid $100 per prescription by local pharmacies who would then bill Medicare for the prescriptions which were sometimes not filled. (It is estimated that Medicare lost approximately $2.5 million from the scam.) The secretary did not act alone. Another employee at the clinic also fabricated subscriptions and was paid $50 per bogus script.

The secretary pleaded guilty to two counts of conspiracy and identity theft. Her co-conspirator pleaded guilty to two counts of conspiracy to commit health care fraud, aggravated identity theft and creating false prescriptions. They are scheduled for sentencing. There is an ongoing related case involving a local pharmacy owner.

Prescription drug abuse is growing problem and the Centers for Medicare and Medicaid Services have increased oversight protection to prevent the damaging effects. The anti-fraud efforts leverage data analysis to combat fraud, waste and abuse, and the agency is now able to eliminate abusive prescribers from the Medicare program. This will go a long ways toward making sure Medicare beneficiaries obtain the treatment they deserve.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Fanny Pack Mixup Unravels Massive Medicare Fraud Scheme,” written by Charles Ornstein and published by ProRepublica.com on July 11, 2014.

The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions — and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.

Now it’s led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.

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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.