Pharmacy Fraud Stings Physicians, Pharmacists, and Patients

Pharmacy fraud is a leading cause of healthcare fraud and abuse. From drug abusers to black market drug sales to unscrupulous healthcare providers, pharmacy fraud is rampant. The National Health Care Anti-Fraud Association (NCHAA) estimates that $100 million is lost every day to healthcare fraud, a significant portion of which is due to pharmacy fraud.

Instances of pharmacy fraud are as numerous as they are devious. One recent example involves an HIV infusion scam that defrauded Medicare of nearly $11 million. A Miami physician and two physician assistants were convicted of multiple counts of healthcare fraud when they were found to have “[seen] no patients, administered no legitimate medical services, and paid a cash kickback to patients for each visit.”

But pharmacy fraud isn’t only perpetrated by healthcare professionals. Some drug abusers “dumpster dive” to gain valuable information. It’s a common practice where the drug addict watches someone leave the pharmacy and/or grocery store and throw away the pharmacy’s drug identification sheet into the dumpster in front of the building. Some pharmacies include a patient’s personal information which the dumpster divers use to both steal identities and illegally purchase pharmaceuticals.

Pharmacies themselves commit pharmacy fraud every day in many different forms, including:
* Billing: Illegal pharmacy billing practices include billing for: brand-name drugs when generics are dispensed, non-existent prescriptions, multiple payers for the same prescription, prescriptions filled but never picked up, splitting prescriptions into smaller days’ supply for additional dispensing fees, or offering or accepting kickbacks.
* Drug shorting: This type of pharmacy fraud occurs when the pharmacy provides less than the quantity prescribed by the doctor and then bills the insurance provider for the full amount.
* Refill errors: Another common form of pharmacy fraud is when a pharmacy dispenses the wrong number of refills prescribed by a doctor.
* Payment scams: Pharmacy fraud also happens when a pharmacy pays a doctor to influence a patient to go to a specific pharmacy, or when a pharmacy waives copays to allure people who would have otherwise used a different store.

Indeed, pharmacy fraud takes many forms. Professional practices, who are so often unwitting victims of pharmacy fraud, need to be vigilant to protect their practices and patients. Prevention begins with education. Hire a healthcare fraud and abuse expert for an unforgettable “Lunch ‘n’ Learn” presentation to teach your employees how to spot and stomp out pharmacy fraud—while also learning how to avoid medical identity theft. Visit www.TheIdentityAdvocate.com or call 310.831.4400 today for more details.