A NYC Criminal Lawyer Explains Pharmacy Fraud
Each year in the United States, more than $300 billion dollars of prescription drugs are sold. These prescriptions are sold through online and local pharmacies, and private or government-sponsored insurance programs pay for the majority of the drugs that are prescribed. Pharmacies bill insurance providers to pay for medications after doctors prescribe them.
In some cases, however, pharmacies engage in fraudulent behavior. Pharmacy fraud can occur in conjunction with other care providers, can involve collusion with drug manufacturers, or can be conducted internally by pharmacists. All those who are part of pharmacy fraud schemes can face serious legal consequences, including both civil and criminal actions.
Those accused of participating in fraud, including pharmacists and pharmacy owners or operators, will need to aggressively defend against all accusations and legal claims. Bukh Law Firm, PLLC can provide legal guidance and representation. When you need a NY criminal lawyer who can assist in developing an effective response to all legal claims you face, give us a call.
What is Pharmacy Fraud?
Pharmacy fraud takes different forms including:
- Billing insurance providers for nonexistent prescriptions or for false prescriptions.
- Billing multiple different payers for the costs of the same medication.
- Billing insurers or patients for name-brand medications while dispensing generic medications to patients.
- Providing a patient with a lesser quantity of a drug than the quantity prescribed and paid for.
- Substituting more expensive medications for lower-cost drugs and billing insurers or patients for the more expensive medications.
In any situation in which a pharmacy or a pharmacist submits a claim to an insurer or a bill to a patient containing false or misleading statements, accusations of pharmacy fraud may be made. Paying or accepting illegal kickbacks– such as compensating doctors for referring patients to the pharmacy or accepting payments from drug companies to prescribe particular medications– is also illegal behavior.
Penalties for Pharmacy Fraud
Pharmacists can lose their license for engaging in fraud. Both pharmacies and pharmacists can face federal criminal charges for fraudulent claims, especially when improper bills were submitted to Medicaid, Medicare, Tricare, or other government health programs. For example, 42 U.S. Code Section 1320a-7b imposes a penalty of a maximum of five years in prison and a maximum $25,000 in fines for making (or causing to be made) false statements and misrepresentations in order to obtain benefits or payments under federal healthcare programs.
The same federal law also imposes the same maximum penalty for accepting, paying or soliciting kickbacks or bribes for healthcare referrals; or kickbacks for purchasing, leasing, or ordering items that will be paid for by federal healthcare programs. This means a pharmacist who pays kickbacks to doctors for referring patients or who accepts kickbacks from drug manufacture could face charges.These federal statutes make pharmacy fraud a felony offense, and it is not uncommon for defendants to be indicted on multiple counts of fraudulent behavior. Civil lawsuits may also be brought under the False Claims Act so the government can recover money paid out to pharmacies because of fraud.
Whistleblowers are encouraged to file Qui Tam lawsuits under the False Claims Act by promises they will receive a portion of the money that the civil lawsuit allows the government to recover. In 2011, for example, a pharmacist at CVS brought a Qui Tam lawsuit and was paid $2.95 million for helping the government recover $17.5 million from CVS that had been improperly paid to the pharmacy. The improper payments were made because CVS billed Medicaid for the entire cost of prescriptions that were also covered by private insurers, instead of just billing for the co-pay paid by the patient.
How a NYC Criminal Lawyer Can Help
Bukh Law Firm, PLLC provides legal representation to pharmacies and pharmacists facing criminal and civil action for fraud. When you need an experienced NYC criminal lawyer with the knowledge and experience to defend you in federal criminal fraud cases, our attorneys are here to help. Call today to learn how we can assist you with developing a comprehensive legal strategy for resolving all criminal and civil claims against you.