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Feds announce telemedicine healthcare fraud scheme

The United States Department of Justice (DOJ) recently announced seven guilty pleas in connection to a telemedicine healthcare fraud scheme. The agency first announced the scheme in December 2020. According to the prosecution, individuals connected to pharmacies were working to defraud pharmacy benefit managers of over $174 million by filing fraudulent prescriptions for pain creams and vitamins.

What are the details of the deals?

According to the DOJ, the most recent to agree to a plea deal, the owner of the pharmacy, has agreed to pay over $24 million in restitution and forfeit another $3 million. He also faces up to 10 years imprisonment.

Additional allegations for those involved in the scheme include conspiracy to commit health care fraud, mail fraud and misbranding. The government has aggressively pursued penalties for those involved in the scheme, with many facing steep financial penalties and prison time.

What can other pharmacies and pharmacy managers learn from this case?

The government is aggressive in looking for and prosecuting those who it believes defraud the healthcare system. The allegations noted above were the result of multiple federal agencies working together, investigating the claims for years before moving forward with the indictment.

Pharmacies and pharmacy managers need to make sure their office is in proper working order to help mitigate the risk of similar charges. Pharmacies should have clear procedures in place to help mitigate the risk of dangerous errors. Regular internal audits can help uncover problems before they grow into a more concerning issue.