The new year has brought with it no lull in pharmacy fraud crackdowns and enforcement actions, with allegations related to over one billion dollars in false claims.
Here’s a breakdown of the latest:
This individual spearheaded a scheme involving kickbacks to marketers and prescribers to defraud TRICARE and other healthcare programs by submitting claims for unnecessary compounded medications, which also involved routine waiver of patient financial responsibility.
In a case that has been years in the making, a fifth Tampa, Florida based defendant has pled guilty to conspiracy to commit healthcare fraud pertaining to allegations of $175M in claims paid by various insurance companies after the submission of almost $1B in false claims.
The false and fraudulent claims stem from the use of telemarketing and telemedicine to bill pharmacy benefit managers for unnecessary and unwanted prescription.
In a reminder that dispensers have a legal obligation to scrutinize and flag suspicious prescriptions, a Florida pharmacy, its pharmacist-owner, and pharmacy technician employee have all been restrained by order of a Federal Court from dispensing controlled substances.
Noteworthy Department of Justice Quotes:
“The Complaint alleges that over a period of several years, the defendants dispensed highly addictive and highly abused prescription opioids while ignoring ‘red flags’ . . . ”
“Medical professionals, including pharmacists, must utilize the best methods of efficacy and accountability when dispensing and distributing dangerous medications”
“Pharmacies and their pharmacists have the responsibility to flag suspicious prescriptions written by doctors for highly sought after opioid medication, in order to prevent them from being dispensed.”