The most common perpetrator of healthcare fraud is usually someone working within the profession who has access to sensitive patient information. This includes, but is not limited to doctors, nurses, medical sales representatives, and pharmacists. An Arlington, Va., man recently pleaded guilty to his role in a healthcare conspiracy fraud which resulted in TRICARE, Virginia Medicaid, Medicare, and Maryland Medicaid being defrauded out of more than $3.5 million.
Onkur Lal worked for various pharmacies which were owned and operated by the same individual. (Coincidence? I think not.) The pharmacies Lal worked for include MedEx Pharmacy, MedEx Health Pharmacy, and Royal Care Pharmacy. Lal conspired with the owner of the pharmacy from 2014 to 2019 to defraud multiple government healthcare insurance programs. (Good news: the pharmacy’s owner has also been convicted for his role in various healthcare schemes.)
Along with other co-conspirators, Lal partook in several healthcare schemes during the course of his employment. This included generating false prescriptions, billing health insurance companies for prescriptions that were never filled, and fraudulently billing patients’ health care benefit programs for numerous high cost medications.
The majority of the high cost prescriptions the pharmacies charged for were either never prescribed, never delivered, or were not medically necessary or requested by the patient. In an attempt to avoid suspicion, Lal and his conspirators would submit false invoices under the name of other pharmacies other than the ones he worked at. (Because the way to get away with a crime is by committing another crime.)
Lal and another co-conspirator also posed as pharmacists and fraudulently changed their title and credentials within the pharmacy’s prescription software system. (Telling people you’re someone you are not doesn’t make it so.) This allowed them to verify prescriptions and further avoid suspicion. (At least until they were caught.)
Impersonating a pharmacist authorized Lal and his colleagues to submit fraudulent prescriptions to healthcare programs and pharmaceutical suppliers so they could receive reimbursement payments. All of Lal’s co-conspirators have been indicted or sentenced for their roles in defrauding insurers out of millions. (I guess they saved the best for last.)
Lal faces up to five years in prison when sentenced in February 2021. This is not the first time that Royal Care Pharmacy has been at the center of a healthcare fraud scheme. See our blog detailing Royal Care Pharmacy’s owner and associates pleading guilty for their roles in an illegal kickback scheme which cost healthcare programs millions of dollars.
If you suspect a healthcare professional of Medicaid fraud or Medicare fraud, please report it by calling 1-800-447-8477 or via email to HHSTips@oig.hhs.gov.
Today’s Fraud of the Day comes from a Department of Justice press release, “Arlington Man Pleads Guilty to $3.5M Healthcare Fraud Conspiracy,” published on October 21, 2020.
ALEXANDRIA, Va. – An Arlington man pleaded guilty yesterday to his role in a conspiracy to commit health care fraud that resulted in losses of over $3.5 million.
According to court documents, Onkur Lal, 29, worked in various roles at MedEx Pharmacy, MedEx Health Pharmacy, and Royal Care Pharmacy, which were all owned and operated by the same individual. From around 2014 to around 2019, Lal conspired with the owner and others in a number of different fraudulent schemes to defraud health care benefit programs, including TRICARE, Medicare, Virginia Medicaid, and Maryland Medicaid. Lal took part in a number of fraudulent schemes, including generating false prescriptions, billing health insurance companies for prescriptions that were never filled, and billing patients’ health care benefit programs for numerous high cost medications that he and his co-conspirators knew were not prescribed and/or never received.
