Health care fraud can lead to serious criminal charges for doctors, nurses and other medical professionals. Recently, the U.S Department of Justice announced it had charged a Houston-area pharmacy owner and his accountant for engaging in an illegal fraud scheme.
While the prosecution is ongoing, the pharmacy owner and the accountant now face eight-count indictments. These counts include health care fraud, conspiracy to commit health care fraud and money laundering.
The health care fraud scheme
The owner-operated pharmacies in Houston, Fort Worth, South Florida and other places. A call center was a major part of the business model. Employees at these centers would call individuals with Medicare and Medicaid insurance to offer unnecessary diabetes supplies. While many customers declined these offers, the pharmacy billed Medicaid and Medicare for them anyway.
Prosecutors allege the scheme did not stop there, as the pharmacy owner also targeted doctors by faxing fraudulent prescriptions. This allowed the pharmacy to bill for prescriptions that were invalid or nonexistent. The total scheme led to profits in excess of $130 million, according to prosecutors.
An expansive investigation
While the pharmacy owner and his accountant have the presumption of innocence, the indictment reflects how seriously federal prosecutors take suspected health care fraud. The scope of the investigation further demonstrates the gravity of the situation. Several federal, state and local agencies played a role in the process.
Upon conviction, the pharmacy owner and the accountant each face decades in federal prison. Ultimately, while the defendants may have some options for defending themselves, the evidence investigators have undoubtedly gathered may persuade the pharmacy owner and his accountant to accept a plea deal.