Medicare Compliance & Reimbursement

How an undercover MFCU investigator can expose a pharmacy fraud scheme.

Providers that bill Medicaid for medications never dispensed can make Medicaid Fraud Control Unit investigators suspicious.

Postiglione Pharmacy Inc. owner John Postiglione, of Port Chester, NY, admitted to defrauding Medicaid of more than $600,000, state Attorney General Eliot Spitzer announced June 27.
 
Between Jan. 1, 1997 and Nov. 3, 2003, Postiglione allegedly submitted claims to Medicaid for expensive medications he never provided.

Bogus list dooms defendant: The medical providers listed on Postiglione's Medicaid claims either never prescribed the medications, or prescribed the medications in lesser amounts than the pharmacist claimed, according to Spitzer. 

NY Undercover Nabs Scrip Fraudster During the investigation, an undercover MFCU investigator posed as a Medicaid beneficiary and gave Postiglione prescriptions to fill.

Postiglione purportedly billed Medicaid for more than $16,000 for medications he didn't dispense to the undercover investigator.

Penalties: Following his guilty plea, Postiglione faces five to 15 years in prison at his Oct. 14 sentencing. He must also make civil and criminal restitution payments of more than $600,000 to Medicaid and the Village of Port Chester at the time of his sentencing.

To read the press release, go to http://www.oag.state.ny.us/press/2005/jun/jun27a_05.html.