Phantom claims can lead to pharmacy billing fraud charges

On Behalf of | Mar 26, 2024 | Fraud

Those who want to work as a pharmacist require years of education to secure professional licensing. They attend graduate school after securing an undergraduate degree and must pass state tests to work as licensed pharmacists. Many of these educated professionals begin their careers with a staggering level of debt. They may then eagerly seek every opportunity available to maximize their income. Yet, particularly when a pharmacist attempts to start their own small practice, how they handle insurance billing could have major implications on organizational revenue.

Some pharmacists may go so far as to engage in fraudulent billing practices to inflate company revenue. They could then end up facing criminal charges, possibly brought by federal authorities in cases involving government insurance programs. Phantom claims are one of the top causes of fraud charges brought against pharmaceutical professionals.

What are phantom claims?

Pharmacists who have treated patients have access to certain medical records and insurance information about those people. They can sometimes choose to use that information to bill for a prescription not provided to the patient.

Oftentimes, federal press releases about pending pharmacy fraud cases relate to pharmacists or their support staff billing for prescription drugs not actually provided to patients. A phantom claim may lead to a pharmacist receiving payment for medication that they did not dispense.

Particularly when there is no patient responsibility for the prescription, possibly because of government insurance, those working in the pharmaceutical industry may view such conduct as victimless crimes. However, the government actively prosecutes those implicated in pharmaceutical fraud cases.

The penalties possible can do major damage

Those who plead guilty or get convicted of pharmaceutical fraud allegations may have to pay restitution based on the alleged acts of fraud. Criminal penalties could include fines and incarceration. Professionals previously involved in fraudulent billing schemes may find themselves ineligible for state licensing even after they serve their sentences.

Those accused of misconduct have one opportunity to protect themselves and their careers from the potential impact of criminal charges. Responding appropriately to pharmaceutical fraud allegations can make all the difference for a licensed professional. Those familiar with the most common forms of pharmacy fraud can avoid professional mistakes that could lead to prosecution.

FindLaw Network
Gary Jay Kaufman
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