Is Your Pharmacy Ethical? Massive Prosecution of Medicare Fraud Cases Rising

Judge u.w. clemon

Recently, a startling case made headlines: the United States Department of Justice charged over 240 people with generating Medicare fraud cases that totaled more than $700 million.

Charges of fraudulent billing, professional malpractice, and violating medication license agreements were all levied on a group that included over 40 doctors and nurses, making it the largest case of Medicare fraud prosecution that this country has seen thus far.

The charges ranged from fraudulent billing to charging Medicare for services that were not provided. Medicare fraud cases are prosecuted every year, but the most recent case was much more extensive. Some pharmacy owners were implicated, and the charges indicated fraudulent activity between business owners, doctors, and some patients that were involved against their will, experts report.

Conspiracy to commit fraud, intentionally involving patients in fulfilling fake prescriptions, illegal receipt of funds by business owners, and submitting falsified claims to insurance for medically unnecessary operations were all charges that were reported as relevant to the recent large-scale lawsuit.

There are thousands of current Medicare fraud cases being investigated, and the topic has been picked up by many high schools as a course of study. Mock trial hearings, with students arguing both for and against the issue, are increasingly common across the country and most teachers do pick mock trial topics that are being discussed in the news.

Unfortunately, Medicare fraud cases have generated fraudulent bills to insurance providers totaling more than $7 billion in the last eight years. Government experts report that they lack the manpower to investigate every lead and instead must rely on “whistleblowers,” insiders with enough information to enable the courts to prosecute cases involving fraud, money laundering, and even professional malpractice.

So far, over $3 billion has been recovered in the last year, and prosecutors hope to be able to track down and return more money to a health care system that serves millions of individuals. But with almost 1,000 new cases being reported in the last year that may wind up being prosecuted as fraud, criminal justice experts are starting to search for new ways to make headway in their fight against fraudulent health care practices.

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