Double Billing


Government investigations and prosecutions involving pharmacies around the country are on the rise, due to an increase in fraudulent Medicare billing schemes. One common tactic for bilking the government healthcare benefits program includes billing for and dispensing large numbers of painkillers and other controlled substances or costly brand name drugs instead of generics that were available and should have been dispensed. But, we all know fraudsters are a creative lot, churning out new scams all the time. A press release from the Department of Justice describes the actions of one pharmacist who used another method to steal money from the government. She directed a scheme to repackage and redistribute prescriptions that had already been billed to Medicare once. (An interesting spin on reduce, reuse, recycle?)

The press release states that over a five-year period, the pharmacist owned and operated an independent pharmacy in Baton Rouge. The 47-year-old woman paid nursing homes and mental health facilities to collect and return unused prescription medications to the pharmacy. The pharmacist then directed her employees to re-package them and re-distribute through other prescriptions while essentially billing Medicare again for the same medication. Her actions caused more than $2.2 million in fraudulent billings. (Not exactly chump change.)

The pharmacy owner pleaded guilty to one count of health care fraud. Sentencing is scheduled for a later date.

Fraudulent activity can often be tied back to independent pharmacies, such as the one in this case, as opposed to chain drug stores nationwide because independent pharmacies tendency to provide more service to local nursing homes, hospice and other extremely ill Medicare patients who use a higher quantity of expensive drugs. Thanks to the efforts of the Medicare Strike Force, this fraudster has been stopped from taking additional benefits she does not deserve. (Let’s hope that her punishment will fit the crime.)

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Owner of Baton Rouge Pharmacy Pleads Guilty for Directing $2.2 Million Health Care Fraud Scheme,” released by the Department of Justice on April 24, 2014.

The owner of a Louisiana pharmacy pleaded guilty today for directing a $2.2 million Medicare fraud scheme to repackage and redistribute prescription medications.

Acting Assistant Attorney General David A. O’Neil of the Justice Department’s Criminal Division, Interim U.S. Attorney J. Walter Green of the Middle District of Louisiana, Special Agent in Charge Mike Fields of the Dallas Region of the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), Special Agent in Charge Michael Anderson of the FBI’s New Orleans Division and Louisiana State Attorney General James Buddy Caldwell made the announcement.

Read More

Previous articleAll in Good Fun
Next articleAn Inside Fraud Job

Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.