Pharmacy Fraud: A Growing Concern in the Industry

When you go to a pharmacy, you expect to be able to get the medications that have been prescribed by the doctor without any difficulty. If you work in a pharmacy, then you know that it can sometimes be hectic and difficult to process all of the medications that need to be filled while making sure all of the insurance payments are received. This is an industry where it’s easy to commit many types of fraud, all of them punishable by the law in some form or another.

Escalating Concerns Over Prescription Drug Fraud

The value of prescription drugs has increased to an astronomical amount over the course of the past few years. There are people who will get medications from a pharmacy and sell them to family members, friends, and strangers in order to make money from them. This is one way to commit fraud. Pharmacists have easy access to medications of all kinds as well as the people who work there. It’s easy to take a bottle of pills that are known to gain a significant amount of money on the street, sell them, put the cost of the prescription back into the pharmacy, and keep the rest as a profit.

Challenges in Combating Pharmacy Fraud

The sheer size of the pharmacy industry makes it easier than ever to commit fraudulent acts. There are some that take money from their own business while others think of ways to defraud the government, getting more money from insurance companies than they are supposed to get. The fraudulent acts are easy to commit as most pharmacies are small in size and are often independently owned unless they are located in a larger store, like a grocery store. Even then, the pharmacy often sits back from the rest of the customers, making it easy for workers to take medications or to do as they wish with the paperwork that is completed so that more money is made.

Tactics Employed in Pharmacy Fraud

One of the ways that pharmacies are committing fraud is by prescription switching. The worker will state that the drug is a name brand when in reality it’s a cheaper version. The company would get paid the higher amount but only spend the amount that is set forth in regards to the least expensive medication. Pharmacies can also switch out a cheaper medication that is prescribed for one that is more expensive. The customer gets the cheaper drug, but the pharmacy gets paid for the one that is the most expensive as this is what is billed for on paper.

Another option is to file a bill for a prescription that doesn’t exist. Most pharmacies do have to keep a copy of the prescriptions that come in, but for those that aren’t required to keep any kind of hard copy, it’s easy to say that a prescription needs to be filled and that the paperwork is lost. The business will get the money since the prescription is processed. This happens often when dealing with insurance companies and government-funded programs as all the worker has to do is turn in a bill of sale for a medication.

Legal Ramifications and Consequences

A similar act is billing several payors for one prescription. If it’s a name-brand medication, then this could result in a significant amount of money for the pharmacy. There is usually no way for each payor to find out if another company has paid for the same medication, making it easy to get as much money as possible.

If you have been charged with pharmacy fraud, it’s best to seek the help of an attorney. You could face time in jail and high fines as this is a severe crime in many states, including New York. Some sentences could be as long as 43 months in jail with maximum fines of $25,000.