$100M Healthcare Fraud Conspiracy Leads to Pharmacy Owner Pleading Guilty

A Florida pharmacy has pled guilty to a $100 million healthcare fraud conspiracy scheme, according to paperwork from federal court. Focused insurance reimbursements were the cornerstone of this healthcare conspiracy fraud scheme. Two conspiracy counts were charged in federal court as released by the U.S. Department of Justice.

In recent years, the federal government has cracked down on healthcare fraud in an effort to avoid wasting taxpayer dollars. Many different variations on federal healthcare fraud exist, most of which have to do with illegal billing practices. A healthcare fraud conspiracy may include Medicaid, Medicare, or Tricare. Most of these cases only lead to criminal charges after a lengthy investigation. Whistleblowers can play an important role bringing healthcare fraud conspiracies to light.

Allegations of Healthcare Fraud Conspiracy Show Evidence of Broad Scheme

The A to Z Pharmacy owner pled guilty to one conspiracy count related to criminally derived property and one count of conspiracy to commit healthcare fraud. Several other individuals have already pled guilty for the roles they played in the scheme. According to the healthcare fraud conspiracy paperwork, the submission of bogus claims involved scar creams and pain creams to Tricare, Medicare and private insurance companies as released by the Department of Justice.

Billing codes were manipulated for the purpose of reimbursement claims and the pharmacy sent in reimbursement claims for ingredients that they did not have, according to the investigation. The A to Z Pharmacy was used as the primary location for the operation and wire transfers and check transfers as well as asset purchases were used to disburse profits from the fraud to shell companies for the co-conspirators. A boat, cars, and real estate were all purchased by the primary individual charged in the healthcare fraud conspiracy using money skimmed from federal funds.

The investigation was conducted together with the FBI, the U.S. Department of Health and Human Services Office of Inspector General, The U.S. Defense Criminal Investigation Service, the Department of Justice, and the Medicare Fraud Strike Force. According to information released by the Medicare Fraud Strike Force, more than 3,500 defendants have been charged since it was brought into inception in 2007.

Federal Government Cracks Down on Healthcare Fraud

Government agencies often work together to stop healthcare fraud and to hold relevant parties accountable when they are identified after an investigation. This can lead to criminal charges for those involved.

In total, those individuals who have been caught with healthcare fraud conspiracy schemes have defrauded the Medicare program for more than $12.5 billion since 2007, according to the Medicare Fraud Strike Force. Whistleblowers often play a crucial role in these healthcare fraud conspiracy cases by sharing information they learn while on the job with federal investigators.

The federal government provides protections for whistleblowers who assist in healthcare fraud investigations. Whistleblowers play a vital role in telling the government details about alleged fraud and laws are in place to protect them from retaliation. Additionally, whistleblowers can be entitled to an award under the False Claims Act.

If you or someone you know believes you have information about a healthcare fraud conspiracy and wishes to discuss it with an attorney, schedule a consultation with Bradley Grombacher today. 

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.