Medicare Compliance & Reimbursement

Undercover investigators could expose a prescription-drug fraud scam

Any pharmacist who is considering committing insurance fraud should be prepared to face a stiff prison sentence if prosecutors find out. A recent case illustrates just how fervent some prosecutors are when pursuing pharmaceutical fraudsters.
 
Insurance fraud prosecutors are proving they're not afraid to pursue prison sentences for pharmacists who devise a scheme to defraud the Medicaid program.

Neptune, NJ-based GLV Parke Warner Pharmacy owner and operator Rammohan Pabbathi received a three-year prison sentence for allegedly defrauding Medicaid, the state Attorney General Peter Harvey announced on July 13. Pabbathi paid $450,000 in fines and restitution to Medicaid prior to his sentencing, Harvey notes.

OIFP Goes Undercover To Get Man
 
In pleading guilty to the health care claims fraud charges, Pabbathi admitted he sent claims to Medicaid for medications he never dispensed. During the Office of Insurance Fraud Prosecutor's undercover investigation, investigators found that Pabbathi paid "kickbacks" to patients and providers for prescriptions he billed to Medicaid providers.
 
Pabbathi also purportedly used "runners" as a part of his scheme to defraud Medicaid, Harvey says.
 
To read the press release, go to http://www.state.nj.us/lps/newsreleases05/pr20050713a.html.