Department of Justice Cracks Down on Insurance Fraud

The U.S. Department of Justice has announced that the former managing pharmacist of a New Jersey pharmacy has pleaded guilty to submitting fraudulent claims to health insurers. The defendant admitted to conspiring with others to submit claims for prescriptions that the pharmacy never dispensed over a five-year period spanning from 2002 to 2007. He could serve up to five years in prison and be forced to pay a hefty fine.

Among the many insurers that fell victim to the fraud was the federal Medicaid program, which insures low-income individuals in conjunction with certain state Medicaid programs. Medicaid and Medicare, which insures those over 65 years old and certain other qualifying individuals, are frequent targets of attempted fraud. The Department of Justice has partnered with the U.S. Department of Health and Human Services to prevent waste and abuse in the system. The goal is to keep the cost of these federal programs down, thus saving money and improving the quality of services provided.

His plea came on the same day as a major health care fraud sting operation resulted in the arrests of 53 individuals, including doctors, executives, and beneficiaries, in the Detroit area. In addition, eight Miami-area residents were arrested today on similar charges.

These recent arrests are a clear indication of the administration’s aggressive policy of attacking Medicaid and Medicare fraud. If you become aware of fraudulent activity, you can report it by e-mailing HHSTips@oig.hhs.gov or by calling 1-800-HHS-TIPS.