Health Care Fraud Sweep Leads to Charges Against Several Pharmacists

Pharmacists were among the 301 individuals charged in the largest health care fraud takedown in history, both in terms of the number of those charged and the amount of money lost.

The Medicare Fraud Strike Force found these individuals to be allegedly responsible for $900 million in false billings, stated Attorney General Loretta E. Lynch and Department of Health and Human Services Secretary Sylvia Mathews Burwell in a press release.

Some of the alleged crimes were conspiracy to commit health care fraud, violations of the anti-kickback statutes, money laundering, and aggravated identity theft. The schemes involved prescription drugs, durable medical equipment, home health care, psychotherapy, and physical and occupational therapy.

More than 60 individuals were arrested for alleged crimes related to Medicare Part D alone.

“As this takedown should make clear, health care fraud is not an abstract violation or benign offense—it is a serious crime,” Lynch said in a press release. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people—many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust—between doctor and patient, between pharmacist and doctor, between taxpayer and government—and pervert them to their own ends.”

The sweep struck 36 federal districts, and notably:

• In the Southern District of Florida, 100 individuals were charged in various fraud schemes related to false billings for home health care, mental health services, and pharmacy fraud.

• In Tampa, Orlando, and the Middle District of Florida, 15 individuals were accused of schemes related to compounding pharmacy fraud and intravenous prescription drug fraud costing $17 million in fraudulent billing. The Department of Justice claimed that the owner of a few infusion clinics defrauded Medicare by more than $8 million. He or she allegedly made reimbursement claims for costly prescription drugs that were never sold or used by patients.

• In New York, a pharmacist was charged for allegedly defrauding Medicare and Medicaid by more than $51 million.

• In Missouri, a physician and pharmacist were allegedly part of a 4-person team to make more than $3 million in fraudulent billings.

• In California, a physician and pharmacist, plus 3 other individuals, were charged for allegedly participating in bribes and kickbacks to physicians in exchange for prescribing expensive equipment and compounded pain creams that were medically unnecessary. These individuals may have been involved in $27 million worth of false and fraudulent claims.

“These criminals target the most vulnerable in our society by taking money away from the care of the elderly, children, and disabled,” said FBI Associate Deputy Director David Bowdich in a press release. “The FBI is committed to working with our partners and the public to stop fraud and ensure that health care dollars are used to help the sick, and not line the pockets of criminals.”

Burwell noted that federal agencies would continue to use new tools and resources, such as the $350 million from the Affordable Care Act, to prevent health care fraud and focus on enforcement.