The government continues to crackdown on allegations of health care fraud. One recent example involves a pharmacist accused of various crimes. According to the complaint, the prosecution has charged the pharmacy owner with two crimes. The first is conspiracy to commit health care fraud and the second conspiracy to pay illegal kickbacks to a physician.
If convicted, he faces over $500,000 in financial penalties and up to 15 years of prison time.
What led to the allegations?
The prosecution has accused the pharmacy owner of using pharmacists to fraudulently complete prior authorization forms for Medicare, Medicaid and private insurance company reimbursement for specialty medications. The pharmacy owner allegedly used the large number of approved preauthorization for reimbursement stats to show physicians his pharmacy had a higher rate of prior approval compared to other pharmacies in the area, attempting to encourage doctors to use his pharmacy for their patient’s prescription needs.
In addition to falsifying paperwork to receive prior authorization for these medications, the pharmacy owner also needs to defend himself against allegations he bribed physicians with cash payments to encourage patients to use his pharmacy.
What can other medical professionals learn from this case?
The pharmacy owner was just recently charged. As a result, he is likely working to build his defense to the allegations. Others who face similar accusations can learn the following from this case:
- Watch what you say. It appears the government investigation was the result of a complaint from one of the pharmacy owner’s employees. Disgruntled employees can make complaints about medical facilities. These employees may save emails, text messages and even record conversations to help build their case.
- Know the law. Some short cuts are legal, others are not. Although it may seem advantageous to have certain medications in supply, falsifying paperwork to build your stock is generally illegal.
- Delegate. Medical practitioners and business owners need to focus on patient care and business operations. Although it is important to take any allegations of wrongdoing seriously, it is also important to acknowledge that it is unlikely you will be able to defeat the allegations on your own. Delegate the matter to a professional.
Legal counsel experienced in allegations of health care fraud can help to better ensure your business interests and legal rights are protected throughout the process.