A New York man recently agreed to a plea deal with the government for allegations of health care fraud. According to his plea agreement, the accused requested blank prescriptions from a physician friend. The accused then put in the names of other patients and made copies of the prescriptions to help perpetrate a fraudulent scheme.
The accused would allegedly find patients that had insurance that would cover the high cost of compound medications. These included BlueCross BlueShield of Western New York and Verizon Medical Expense Plan for New York as well as the New York and New England Associates, National Grid USA and Sunovion Pharmaceuticals. Compound medications are more expensive because they involve a physician or pharmacist mixing together different medications to develop one that caters to the specific patient’s needs.
After facing the evidence, the accused chose to agree to a plea deal. The deal included a confession of guilt. The case provides an opportunity to discuss the importance of carefully reviewing a plea deal before agreeing to the terms. In this case, even with his cooperation the court sentenced the accused to three years imprisonment and $10 million in restitution. Although the accused admitted that the health insurance companies liked lost $10 million in the alleged scheme, he stated he only received a fraction of the funds and has already agreed to forfeit $225,000 to the government.
Yet the court appears to hold him accountable for the full amount.
The government has stated the investigation into the scheme continues. As a result, others may face charges in the future.