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Another pharmacist arrest shows prevalence of fraud cases

Like physicians, pharmacists have a duty to serve patients to the best of their ability, see to their well-being and protect them from harm.

The arrests of two New York pharmacists shows how such responsibility can go astray. Unfortunately, they used their expertise for personal gain rather than the greater good.

The auto-filling case

"Auto-filling" is a term given to the scheme of submitting claims to insurers such as Medicaid for prescription refills that have never been made. Acting on a tip, undercover agents who posed as Medicaid recipients investigated the three pharmacies where the fraudulent scheme was allegedly underway. The pharmacists paid cash to the undercover agents for HIV prescriptions and referrals of other patients to their pharmacies.

The penalties

Authorities arrested the owner of the three New York pharmacies and her supervising pharmacist in August 2017. As a result of their interaction with the undercover agents, they were charged with receiving more than $60,000 for the prescription refills they processed for those agents alone. However, between 2014 and 2017, they billed more than $11 million to insurers such as Medicaid, but actually purchased only a small amount of the drugs they would have needed to fill prescriptions in that kind of volume. The charges against the two pharmacists included grand larceny, health care fraud and class C and E felonies. The charges bring potential prison terms of from 15 to 25 years.

Possible problems for you

There are many federal and state regulations that affect pharmacists. The regulations change frequently, and it is not easy to keep up. As a pharmacist or pharmacy owner, you are undoubtedly aware that government agencies and law enforcement personnel often run checks to uncover fraudulent practices. It is possible that you might find yourself under investigation for suspected illegal activities at some point, but an experienced health care attorney will remind you that you have options. You may run afoul of the law even if you have been making every effort to comply, but you can reach out for legal assistance to get your business and integrity as a pharmacist back on track.

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