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Health care and insurance fraud alive and well in Florida

It seems that South Florida, along with the rest of the state, is regularly inundated with news of the next big fraud case in the Sunshine State. Lately, though, it seems a like a lot of the news centers on fraud claims in the health and insurance industries. In the last few weeks, for example, law enforcement agencies have busted people involved in property insurance fraud, while defendants involved in large-scale home health care and pharmacy fraud schemes received sizable sentences.

In one such instance, a central-Florida pharmacy owner was handed 13 years in federal prison for a kickback scheme that involved two other people and netted millions of dollars. In the scheme, the pharmacy owner worked with pre-selected doctors who would prescribe expensive medications to their patients – some as much as $17,000 for a single prescription – which would be filled at the defendant’s pharmacy.

The pharmacy owner’s accomplices identified patients and steered them toward the doctors who worked with the pharmacy. In return for steering the patients to the doctors, the accomplices would receive kickbacks from the pharmacy owner. The medications were billed to TRICARE, a Department of Defense health care program that provides benefits for military personnel, retirees and their families. TRICARE paid for the medicines involved in the fraud scheme.

The government ordered the pharmacy owner to pay more than $4 million in restitution. Recovering the amount owed will likely involve liquidating any assets and property the defendant owned. Often, a court will appoint a receiver – usually an attorney or firm with considerable experience in such matters – to collect and liquidate the assets of those convicted in a fraud scheme.

Source: CBS Miami, “Florida pharmacy owner gets 13 years for health care fraud,” Apr. 1, 2018

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