Patients pick up prescriptions from pharmacies every day, never thinking that some sort of fraud may be taking place in the background.
However, while many pharmacies follow legal procedures in serving the public, others engage in fraudulent activities that cost Medicare billions of dollars annually.
One type of Medicare fraud occurs when the pharmacist fills a prescription with a medication different from the one a doctor prescribed. Switching from tablets to capsules or vice-versa is a wrongful act and a way of taking money from the government.
A pharmacist might refill a prescription automatically although the patient did not request it. The pharmacy will then bill Medicare for a prescription the patient did not order and never picked up.
Kickbacks and bribes
Large pharmaceutical companies may bribe pharmacists to switch a patient’s medication to their own brand. On the other hand, a pharmacy might use incentives such as gift cards to induce patients to transfer their Medicare prescriptions from another provider. The pharmacy can then use these government—paid prescriptions in a fraudulent manner.
False Claim Act
Most pharmacy fraud cases come to light when a whistleblower provides information under the False Claims Act. Whistleblowers are often current or previous employees of pharmacies, hospitals or doctors’ offices. An investigation into the possibility of pharmacy fraud is usually a lengthy, detail-oriented undertaking. The time to begin building a defense strategy is in the early stages when someone suspects he or she might be the target of such an investigation.