Some pharmacies automatically refill prescriptions that have been prescribed
by a doctor. The courtesy can be a real time-saver. When you are getting
low on a prescription, you can head down to the drug store any time, knowing
your prescription will be waiting for you. But the feds allege that a
Baltimore pharmacy turned a courtesy into a scheme to commit Medicare
and Medicaid pharmacy fraud. According to indictments filed in the case,
the pharmacy owner and employees were billing Medicare and Medicaid for
refills even when the patient never picked up the drug. To add insult
to injury, they then restocked the drugs and resold them to Medicare and
Medicaid when the next patient came along.
When a pharmacy automatically refills a prescription, most patients will
pick up the refill — but not every patient will. Sometimes the prescription
may sit in the basket at the pharmacy, never claimed. Perhaps the patient
has moved and changed pharmacies. The patient may have decided that the
prescription was too expensive, or that he or she didn’t need to
take it anymore. In all of these situations, the pharmacy is left with
the prescription sitting in the basket of medications waiting to be picked
up. Most pharmacies cull through the baskets every few days, and restock
the pills or medications that have not been picked up. Until the patient
picks up the prescription refill, no one is charged for the drug –
not Medicare, Medicaid, a private insurance company, or the patient.
But according to an indictment filed against a pharmacy’s owner and
two employees of the business, a Baltimore pharmacy was gaming the system.
A Baltimore Sun article,
Two from Harford charged with bilking Medicare, Medicaid on prescription refills, reports that two employees and the drug store owner were billing Medicare
and Medicaid before the patient showed up. Then, when a prescription went
unclaimed, they did not let Medicare or Medicaid know that the pills had
not been picked up. Instead, they restocked the pills and used them when
a new patient came in with a prescription for that particular drug. Thus,
Medicare and Medicaid wound up paying twice for the very same pills or drugs.
The indictments say the scheme netted the pharmacies $ 2.6 million in reimbursements
for prescriptions that were never provided to patients, but instead were
According to the Baltimore Sun, a grand jury now has returned an indictment
against Reddy Vijay Annappareddy, the owner of Pharmacare, LLC, and Caremerica,
LLC. Two employees, Jigar Patel and Vipinkumar Patel, apparently no relation
to one another, also were indicted and arrested. On July 25, 2013, the
feds swept three pharmacies and a storage space for documents, looking
for evidence in the case.
Is this type of drug store Medicare fraud rampant? I have not heard about
this type of fraud happening, but as my friend Patrick Burns pointed out,
when fraud is this simple and this lucrative, chances are that it is happening
in more than one place. If so, I hope there are some drug store whistleblower
employees who will come forward. They would be helping Medicare, Medicaid,
and all of us as taxpayers. And if instead they keep silent and restock
the pills, they may wind up like the Patels – employees who stand
accused of being involved in the fraud.