Providing illegal healthcare kickbacks to Medicare beneficiaries in exchange for promises to fill their prescriptions at that pharmacy and allowing the pharmacy to submit claims to Medicare for prescription drugs that were never provided is a violation of the Anti-Kickback Law and the False Claims Act
Compliance Perspective – Prescription Drugs
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review the policies and procedures regarding vendor contracts with pharmacies.
Training: The Compliance and Ethics Officer with the Business Office Manager and Administrator will ensure that staff are trained regarding vendor contracts and background checks, including checking databases for exclusion from participating in the Medicare program. Residents and their families would benefit from educational materials regarding kickback scams and how to prevent their Medicare identities from being used for fraudulent purposes.
Audit: The Compliance and Ethics Officer should personally conduct interviews with residents to determine if they have unknowingly allowed their identities to be used for fraudulent, false claims submission.
IDENTITY THEFT: DETROIT MAN STEALS 1000 IDENTITIES
Antonio Perez, Jr., owner of a Miami Florida-area pharmacy was recently sentenced to seven plus years in prison for his role in an $8.4 million Medicare fraud scheme that occurred over a six-year period and involved prescription drugs that were never provided to beneficiaries.
Perez was sentenced by a U.S. District Judge in the Southern District of Florida and also ordered to pay $8,415,824 in restitution and to forfeit the same amount. Perez must forfeit four Miami-area properties worth approximately $700,000 and multiple bank accounts totaling over $250,000. Perez previously pleaded guilty to one count of conspiracy to commit health care fraud.
According to admissions made as part of his plea agreement, Perez was the owner of A.R.A. Medical Services Inc., which did business under the name Valles Pharmacy Discount. Perez admitted that he had agreed to pay illegal health care kickbacks to Medicare beneficiaries in exchange for their promises to fill their prescriptions at Valles Pharmacy Discount, and to allow Valles Pharmacy Discount to submit claims to Medicare for prescription drugs that were not provided to the beneficiaries. Perez admitted that he submitted claims to Medicare for expensive prescription medications that Valles Pharmacy never purchased, and never provided to Medicare beneficiaries.
During the six-year period of the scheme,Medicare paid Valles Pharmacy Discount over $32 million, of which at least $8.4 million was for prescription drugs that Valles Pharmacy never purchased and never provided to Medicare beneficiaries.
