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2 important lessons from recent health care fraud case

A recent investigation by the United States Department of Health and Human Services Office of Inspector General’s New York Field Office has resulted in criminal charges against two New Yorkers who allegedly posed as pharmacy owners as part of a scheme to take advantage of relaxed Medicare billing requirements. The feds state the men, who owned more than a dozen pharmacies throughout New York City and Long Island, made multiple false claims for reimbursement to Medicare. Ultimately, the government says these men illegally took $30 million from the Medicare system.

What are the allegations?

According to the indictment, the two New Yorkers used COVID-19 emergency override billing codes to submit claims for expensive cancer medications. The prosecution claims to have evidence the accused forged physician’s signatures on prescriptions and claimed to fill the prescriptions at times when the listed pharmacy was not even open for business. The feds also claim the individuals used an elaborate system to launder the proceeds until they appeared legitimate.

Once the evidence was gathered, the prosecution moved forward with criminal charges. The feds have accused the men of the following: conspiracy to commit health care fraud, wire fraud, and conspiracy to commit money laundering.

What does this mean for other medical professionals?

The Federal Bureau of Investigation (FBI) has stated that it is receiving tips about various fraudulent schemes in connection to the pandemic. The feds will investigate these tips and an investigation can result in allegations of wrongdoing.

Navigating the nuances of constantly changing laws is not easy. Medical practitioners who are concerned can conduct an internal audit to better ensure their practices are in line with applicable regulations.