Federal agencies make detection of Medicare fraud a high priority due to the large sums of money involved. Pharmacists can come under as much scrutiny as medical doctors by federal investigators from the Department of Health and Human Services, Office of Inspector General and FBI who work with law enforcement agencies in California and throughout the country. The conviction of a Calabasas pharmacist and owner of two pharmacy companies illustrates the prescription drug-related activities that can lead to criminal charges.
Have the government pay for black market pill supplies
Evidence presented against the 53-year-old pharmacist that resulted in conviction revealed a conspiracy dependent on billing Medi-Cal or Medicare for patients’ prescription drugs but then selling them on the black market. Court documents showed that she sent through claims for reimbursement of prescription drugs that were never given to the patients cited on the billing paperwork.
Where the prescriptions came from
The pharmacist and her co-conspirators generated prescriptions either by writing fake scripts or paying kickbacks to health care providers willing to write prescriptions for patients in their systems. The paperwork trail created by these activities allowed federal authorities to secure a conviction against her involving pharmaceutical fraud charges.
To ensure payment and a supply of pills valuable on the black market, the pharmacist informed her co-conspirators of the desired drugs. She then matched them with patients whose records indicated that they would qualify for government reimbursement.
Billions in fraud detected by government
The Health Care Fraud Strike Force Program started in 2007 to investigate suspicious billing activity to government-funded medical programs. The program works throughout 24 federal districts in 15 separate strike forces. Since its inception, the program has charged over 4,200 people for schemes that billed the government for over $19 billion in fake claims.