Medicare and Medicaid are federally funded health insurance programs that provide medical coverage to elderly and low-income individuals, respectively. Because pharmaceutical fraud involving Medicare or Medicaid costs taxpayers money, you can potentially suffer very serious penalties for it if charged and convicted.
It is not clear exactly how much money Medicare fraud costs the government every year. However, according to Pharmacy Times, the pharmacist involved in the largest takedown allegedly defrauded the government of $50 million alone. Medicare fraud can take several different forms.
If you were to fill a patient’s prescription with something different and more expensive than what the doctor ordered, that would be an example of drug-switching fraud. The government would regard this as wrongly taking taxpayer money even if it was a relatively simple and seemingly harmless change. For example, if you were to fill a patient’s prescription with capsules when the doctor ordered tablets, that could be an instance of drug-switching fraud even if it is the same medication that the doctor prescribed.
Automatic refills can be very convenient for patients, especially the elderly who may have issues with memory or mobility. However, if the patient did not request the refill and does not even know about it, that is an example of auto-refilling fraud. It involves billing Medicare for a prescription the patient does not need. It is possible to repeat this scheme a number of times because the medications remain in the store. Patients do not pick them up because they do not know about them.
The federal government now has a strike force in place to contend with the widespread problem of Medicare fraud.