Communication is Key

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Communication is Key

Good communication skills are necessary to have a successful marriage. But due to some miscommunication between a New Haven, Connecticut doctor and her husband, they are now responsible for their involvement in a healthcare fraud scheme that stole $1.5 million from state and federal government health programs, including TRICARE which serves U.S. military members and their families.

Today’s case stems from a report by Connecticut’s state comptroller in 2015, where it was noted that the state’s taxpayer-funded prescription plan had a nearly 3,000 percent increase in costs for state government employees, retirees and their dependents. When the comptroller’s office took a deeper look into the matter, a multitude of compound medicine prescriptions were discovered. Compound medicines are medications and creams that are mixed together to treat pain and skin conditions like scarring. (Compounding pharmacies can charge up to $10,000 for a one-month supply even though some medications are combinations of affordable over-the-counter drugs. That’s highway robbery!)

When investigators dug deeper into the compounding matter, they found that today’s fraudster was employed as a physician for a medical group where she wrote compounding medication prescriptions for patients she never saw or examined. (Apparently, she also signed blank prescriptions and handed them over to her husband.)

Here’s what was going on behind the scenes. The physician’s husband was a Connecticut state employee and a sales representative for a compounding pharmacy. (It’s also important to mention that the husband’s cousin worked as a pharmacy sales rep. He earned commissions on every topical prescription drug cream he sold. Get where we’re going here?) The husband allegedly approached his state-employee co-workers at UConn’s Stamford campus to encourage them to try compounding medicines that were produced by the pharmacy he was also working for. (The article states that his wife knew her actions were wrong, but she wrote the prescriptions for the compounded medications without examining them anyway.) The government health programs paid $1.5 million for the prescriptions to the compounding pharmacy, then the company paid commissions of between 15 percent and 25 percent to their sales reps.

So, what happened to the Connecticut couple? Well, after their communication breakdown and their healthcare fraud scheme, the two are no longer living together. The 38-year-old physician pleaded guilty to healthcare fraud for scheming with her husband to defraud Connecticut’s state-employee prescription plan and other government health programs. (Because she entered a guilty plea, 18 other criminal counts against her were dropped.) She is facing up to 51 months in prison.

The doctor’s husband resigned from UConn following a 15-month period of paid leave. (But, the State of Connecticut continued to pay his $65,000 annual salary while he was under investigation. That’s just ridiculous. He should have to payback his salary.) Although he faced 19 counts related to healthcare fraud, he was convicted on only two of the charges. He is facing a maximum prison sentence of 20 years.

The communication breakdown between the Connecticut couple occurred when the physician failed to say “no” to the crime her husband encouraged her to commit. (Remember, she knew what she was doing was wrong.) Perhaps it was because of love, or maybe just plain greed that motivated them both to carry out their healthcare fraud scheme. Regardless of why they did what they did, the government will clearly communicate their punishment when sentenced so there is no doubt as to how they will make up for the crime they committed.

Today’s “Fraud of the Day” is based on an article entitled, “Jon Lender: Doctor pleads guilty in compound medicine case that defrauded Connecticut taxpayers,” published by Hartford Courant on January 19, 2019.

A physician pleaded guilty Friday in U.S. District Court in New Haven to a count of conspiracy to commit health care fraud — in an alleged scheme with her husband to defraud Connecticut’s state-employee prescription benefit plan, as well as other government health programs, by submitting prescriptions for very expensive “compound medications” produced by a Mississippi-based pharmacy in 2014 and 2015.

Dr. Kakra Gyambibi, 38, entered the plea before U.S. District Judge Jeffrey Meyer under an agreement with the office of U.S. Attorney John H. Durham that 18 other criminal counts against her would be dropped. Sentencing was set for April 12, with a written understanding that government guidelines call for a sentence of 41 to 51 months in prison. However, her defense attorney, Frank Riccio of Bridgeport, reserved the right to argue for “for a sentence below that range,” including a “no-jail” sentence. Meyer ordered a pre-sentence investigation by the U.S. Probation Office, with a first draft due March 1.

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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.