Healthcare Compliance Perspective:
An effective Compliance and Ethics Program requires a good faith effort to detect and prevent fraud, waste and abuse.
Cousins who are not only are related to each other, they also admitted they were involved together in a nearly 3-year-long $2.6 million Medicare and Medicaid fraud involving two Hialeah pharmacies. Last month the Florida DOH ordered an emergency suspension applied to the cousins. Last year, the cousins each pleaded guilty to charges of conspiracy and committing wire and healthcare fraud.
The cousins will not be together while they are incarcerated. One will be at FCI Coleman until the end of March 2020, and the other will be serving time in a minimum security federal prison camp in Alderson, West Virginia until January 2019.
One of the cousins worked for the other who was the owner of the pharmacies involved. The healthcare fraud they perpetrated involved paying cash kickbacks to Medicare and Medicaid patients to use their identification numbers. The pair would then submit claims for reimbursement of prescription drugs and other healthcare items that the pharmacies had not provided.
Ironically, while both cousins defrauded the government out of $2.6 million, both cousins were involved in bankruptcy filings-one filed Chapter 13 bankruptcy which was dismissed due to failure to file information in 2015, but the other filed Chapter 7 bankruptcy claiming she had a monthly salary of $1,733.33, $263 in food stamps and $100 from family members. She also claimed that all she had in her wallet was $10 and only $200 in the bank. The court then discharged her $49,194 in credit card debt without payment.
