Medicare Fraud Exposed

Medicare fraud is not without consequences. Engaging in illegal kickbacks, such as paying or receiving payments for referrals, can lead to serious penalties. These penalties include prison time and hefty fines under the Anti-Kickback Statute, as well as other Medicare and Medicaid Fraud laws. Recently, a Georgia man was sentenced to 46 months in prison and ordered to repay $7.2 million to Medicare for his role in a conspiracy to pay and receive illegal kickbacks. The scheme involved persuading Medicare beneficiaries to undergo medically unnecessary genetic tests that were then billed to the program.

In pharmacy settings, similar schemes can occur if personnel knowingly participate in or turn a blind eye to improper payments for referrals or unnecessary services tied to medication, testing, or supplies. To protect yourself and your pharmacy, train staff on Medicare & Medicaid fraud laws and how to comply with them, avoid any involvement in referral incentives, and promptly report suspicious behavior to Alabama Senior Medicare Patrol or call 1-800-MEDICARE.

See the full Department of Justice case summary for details on the story. To learn more about these laws, review issues 23 and 25–27 of our newsletter or visit the Office of Inspector General’s Fraud and Abuse Laws page for additional information.