December has been a month filled with pharmacy fraud arrests, convictions and court cases, particularly within the last week.
In Columbus, a federal grand jury charged licensed pharmacist Maria Mascio, 59, with 46 counts of fraud, including 37 counts of healthcare false statements, according to an FBI release. Mascio, owner of two healthcare facilities, Family Medical Pharmacy and Vision Systems, allegedly billed for sample drugs and medications that had not been dispensed, and stole the identification of another person to bill for medications. Investigators allege that she mantained this scam from 2003 through 2013.
In Baltimore, a federal jury convicted Reddy Vijay Annappareddy, 46, owner of Pharmacare LLC and Caremerica LLC in Maryland, of healthcare fraud and aggravated identity theft, along with submitting false claims for prescription refills, according to a release from the United States Attorney's Office, District of Maryland. Annappareddy and his co-conspirators billed Medicare and Medicaid for prescription refills without customer consent or knowledge. These automatic refills were often expensive HIV and cancer medications that cost the government at least $2.5 million.
Earlier this month, two administrators at a Grand Rapids-based pharmacy were sentenced for their role in a scheme to package and sell old drugs. According to WOOD8, Richard Clark, former director of sales at Kentwood Pharmacy, was sentenced to 14 years in prison, four of which were tacked on after also pleading guilty to a child pornography charge. Lawrence Harden, the chief pharmacists at Kentwood, was sentenced to six years. Harden and Clark conspired with 15 others, including the CEO, to collect old drugs from nursing homes, repackage them, and resell them as new, charging $60 million to Medicare, Medicaid and Blue Cross Blue Shield of Michigan in the process.
On the West Coast, a federal judge in Fresno reissued a whistleblower award of more than $1 million to Sami Mitri, a pharmacist that was fired by Walgreens for alerting company officials to concerns of billing fraud, according to the Fresno Bee. A U.S. District Court judge originally threw out the award, but an appellatte court returned the sum in a decision this month.
Finally, the 7th Circuit Court of Appeals affirmed a dismissal of a False Claims Act case against Ukrainian Village Pharmacy Inc. In the case, a pharmacist formally employed by the defendant, described by the judge as a "bounty hunter," claimed the company defrauded the government by providing gifts such as caviar to customers as a way to entice them to continue refilling prescriptions there. The case focused on the claims that these gifts were considered kickbacks. However, the judge affirmed a lower court's dismissal, stating that the "complaint that the defendants violated the False Claims Act" was "fatally deficient."
Criminals say that forging prescriptions is easy due to lax prescribing laws, limited tracking systems and medical professionals' resistance to stricter practices, FierceHealthPayer: AntiFraud previously reported.