The Southern District of Texas recently accused a Texas pharmacy owner of an elaborate health care fraud scheme. During the investigation, the prosecution gathered evidence to support allegations a city official was also involved in the scheme. The accusations were serious and included involvement in an alleged scheme to receive over $1.7 million in false payments from Blue Cross and Blue Shield of Texas.
Details of the allegations: Health care fraud
The prosecution initially accused the pharmacy owner, along with a marketer at the pharmacy, of providing free meals to employees of businesses that carry Blue Cross and Blue Shield insurance. Employees would receive these meals in exchange for providing their health insurance information. The individuals behind this scheme would then allegedly use this information to file false and medically unnecessary claims for reimbursement for pain medications to the insurance company.
The insurance company states they provided the pharmacy with payments to cover claims for the pain medications — pain medications neither medically needed or received by the employees covered by the plan.
According to the indictment, the allegations lead to 16 criminal charges including health care fraud and aggravated identity theft.
The allegations expand: City official accused of involvement
These charges included allegations a city commissioner conspired with the owner to commit these crimes. The city official entered a plea deal. He was recently sentenced to two-years imprisonment and required to pay $1.4 million in restitution to the insurance company.
Lessons for others: Allegations of health care fraud can involve more than medical professionals
This case provides a valuable lesson: you do not need to be a doctor, nurse or medical professional to face allegations of health care fraud. Do not take such accusations lightly. If you are accused of a crime, seek legal counsel. A conviction can come with serious penalties, as noted in this case.