A Taste of Their Own Medicine – Pharmacists Defrauding the Healthcare System…and getting caught

Posted by Frank Strafford on February 4, 2016 in Exclusion Screening, Industry News,

Medicaid and Medicare frauds

Medicaid and Medicare frauds run to the tune of billions of dollars each year. Running a check on OIG exclusions is one way to catch this fraud, and also protect one’s healthcare system from doing business with blacklisted entities and individuals.

Pharmacists are an important cog that ensure that smooth running of the healthcare system. When pharmacists go rogue, they can bilk the system out of millions of dollars by billing for medicines not supplied, billing Medicaid and the private insurance company, and receiving kickbacks from a healthcare provider for defrauding government healthcare insurance plans.

Not a day goes by without news about pharmacists getting caught by state and federal agencies for fraud. The new year’s just begun, but if you have been following news related to LEIE checks and healthcare frauds, you’d know that already scams to the tune of millions of dollars have been unearthed.

The second fortnight of January 2016 saw the coming to light of the largest ever healthcare fraud in the state of Nebraska. The fraud, a result of one Lincoln-based pharmacist’s gambling addiction, amounted to a sum of $14.4 million and yielded the now remorseful individual two houses, a boat, hundreds of thousands in spare cash, and many fancy cars. But, at the end of it all, the 2,376 thefts earned the accused ten years in jail.  

Another Medicaid fraud, on a much smaller scale, was found in Beatrice, Nebraska. The pharmacist was billing for brand-name drugs while dispensing generic drugs. The fraud, $38,000, has sadly claimed the life of the pharmacist, who was found dead in his basement.

In July last year, the judge in the federal court in Brooklyn, New York, threw the rule-book at an accused pharmacist who bent every rule to divert taxpayer funds for personal benefits. The pharmacist was indicted on twenty-four counts for defrauding both Medicaid and Medicare on more than $5 million.  

This year, in the state of Massachusetts, the attorney general’s office will join forces with the DEA and FBI to track and stop doctors and pharmacists who may be guilty of illegally prescribing pain medications, and then billing Medicare and Medicaid for these prescriptions.

Beginning this year, pharmacists can expect more audits from the Office of Inspector General (OIG) as it aims to broaden its investigations of Medicare Part D billing and claims.  

Even though the penalties are stiff and vigilance constant, frauds in healthcare continue. Many fraudsters and embezzlers continue to operate and exploit weaknesses in the drug supply chain. This has ramifications for honest businesses. For a healthcare provider to enjoy peace of mind, maintain trust with consumers, and stay on the right side of the law, a little due diligence is imperative. OIG exclusion screening ensures healthcare compliance, and saves your nursing home, hospital, or private practice from punitive action.

About Frank Strafford

About Frank Strafford

Related Articles

Jimmy Kimmel Monologue Inspires National Nurses ...

May 9, 2017

Late night television host Jimmy Kimmel tearfully told the story of his newborn son’s recent birth and open-heart surgery due to a heart defect. In his monologue, Kimmel explained that it was an att...

Interested in Telehealth? So is the ...

May 18, 2022

Telehealth had been a small part of healthcare for many years, but the declaration of a Public Health Emergency (PHE) in 2020 accelerated both its use and scope when in-person healthcare services were...

The Role of Delegated Entities in ...

December 14, 2021

Under federal law, Medicare Advantage plans and Part D plan sponsors may delegate administrative or healthcare service functions to third parties, such as a medical group, pharmacy benefit manager, cl...

Understanding OIG Exclusions

OIG Exclusions Screening Process

Exclusion FAQS

Quick OIG Exclusion Basics

Employing Excluded Individuals

Consequences to Employing an Excluded Individual

OIG Compliance Law

Laws and Publications on OIG Compliance

More Compliance Resources

About Us

Industry leader Streamline Verify has been forging new paths in Exclusion Screening.

Trusted for Good Reason

  • ✓ Guaranteed accurate
  • ✓ Certified Secure
  • ✓ Audit Proof
  • ✓ Feature-rich reporting
  • ✓ Round the clock real-time-data
  • ✓ Processing fully automated

Security First

  • ✓ Cloud hosted
  • ✓ Encrypted data
  • ✓ Real-time backups

Trusted for Accuracy

  • ✓ Physical security
  • ✓ Restricted access
  • ✓ Single sign-on
  • ✓ Password security
  • ✓ Certified secure
  • ✓ Cross checking

HEALTHCARE ESTABLISHMENTS NATIONWIDE COUNT ON STREAMLINE VERIFY

5

60%

Average workload reduction by implementing the Streamline Verify program

5

10K

Establishments trust Streamline Verify nationwide

5

2011

Serving the healthcare industry’s unique compliance needs since 2011

5

24X

Setting standards with hourly synchronization to primary source data

[class^="wpforms-"]
[class^="wpforms-"]