An investigation that spanned many months recently resulted in the arrest of a New York-licensed pharmacist accused of running a “medicine-for-case” scam. The Office of the Insurance Fraud Prosecutor recently announced the charges against this and 18 additional individuals allegedly involved in the scam, which allegedly ran from January through August of 2018.
According to the agency, the investigation also allegedly led to the recovery of over $11 million in connection to the scam. The recovered assets were the result of discovering prescription medications valued at almost $7 million and over $4 million in alleged illegal profits.
The agency states the scheme involved Medicaid beneficiaries filling their prescriptions and then selling the medications to another individual. This other individual, referred to as a runner, would then bring the drugs back to the pharmacy, where they would be returned to the wholesaler or distributor when they expired.
The wholesaler or distributor would then pay the pharmacist up to 85% of the original cost of the now expired medication. The prosecution claims the pharmacist would essentially double charge for the drug, getting full payment from Medicaid and additional payment from the distributor.
The pharmacist faces criminal charges of second and third-degree conspiracy, second degree possession with intent to distribute a prescription drug and third-degree Medicaid fraud. If convicted, a second-degree charge can come with a 5 to 10-year prison sentence and up to $150,000 in fines. A third degree comes with three to five years imprisonment and $15,000 fine.
This case highlights the steep penalties pharmacists can face if accused of insurance fraud. Those who face these allegations have options. An attorney experienced in insurance fraud cases can build a case to protect your rights.