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More Medicare fraud investigations focus on pharmacists

Florida is known for its beautiful beaches and tourist attractions. However, you may not realize that in 2007, the Department of Justice and the U.S. Department of Health and Human Services selected Florida to be the site of their first strike force to fight Medicare fraud. Now, more than a dozen strike forces exist across the country, but their mission is the same: to find and stop Medicare fraud that costs the taxpayers billions of dollars.

Falsely billing Medicare for services is nothing new. The complexity of the Medicare system seems to make it easy for cases of fraud to get lost in the shuffle, and this can be a great temptation to those involved in billing for medical services. However, more pharmacists and owners of pharmacies are finding themselves under the microscope. If this includes you, there are some important facts you should know.

Pharmacies in the crosshairs

The DOJ and other federal and state agencies are serious about stopping fraud in federal medical assistance programs, including fraud related to prescription drugs. If you or the pharmacy you own is under investigation, it is likely that authorities have already decided to prosecute to the fullest extent of the law anyone involved in fraudulent schemes. Some of the common examples of fraud authorities have prosecuted recently include the following:

  • Pharmacy owners who write prescriptions for opioids in bulk then sell the drugs to couriers
  • Pharmacies that pay doctors to sign prewritten prescriptions for expensive compounded medications patients do not need, then billing government and private insurers for the cost of the medications
  • Pharmacists who pay marketers for referring patients who have Medicare insurance
  • Pharmacy owners who submit claims for prescription drugs no patient ordered or received

These are just a few examples. The strike forces have filed charges against almost 4,000 pharmacy owners and pharmacists, alleging they participated in practices of fraud netting more than $14 billion dollars. If authorities are investigating the pharmacy where you work, it is possible there are numerous charges involved. Fraud allegations rarely include a single count but may also include charges such as conspiracy, money laundering, violating anti-kickbacks laws and other white collar crimes.

A conviction for involvement in Medicare or other health care fraud can be ruinous to you career as a pharmacist or detrimental to your ownership of a pharmacy. Even if authorities have not yet charged you with a crime, if you suspect the investigation is heading in that direction, you would be wise to obtain legal representation.

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