2024 National Health Care Fraud Takedown

On June 27^th the U.S. Department of Justice (DOJ) issued a press release outlining a National Health Care Fraud Enforcement Action that resulted in 193 defendants charged, including doctors, nurses and pharmacists, and over $2.75 billion in false claims. This year marked the highest numbers since 2020 and included coordinated efforts by the DOJ, US attorneys’ offices, HHS Office of Inspector General, FBI, and the DEA.

Takedowns related to prescription drugs included:

Illegitimate distribution of Adderall^® and other controlled substance stimulants via telemedicine
Distribution of diverted HIV medications through gray market wholesalers
Medically unnecessary prescriptions for compounds and foot baths
Submission of claims to federal payors for drugs that were not purchased or dispensed
Providing kickbacks to patients to fill medically unnecessary prescriptions
Bribing physicians with cash and entertainment to refer prescriptions

For 15 years, PAAS National^®’s FWA/HIPAA compliance program has helped educate community pharmacies on federal regulations. Coupled with audit assistance and the Newsline, PAAS serves as a guiding light, steering pharmacies away from trouble and towards compliance. The FWA program not only meets CMS’ definition (and PBM requirements) of an effective compliance program, but also helps with written Policies and Procedure for credentialing.

PAAS Tips:

For more insight into these compliance issues, PAAS Audit Assistance members can consider reading the following articles (many more articles available on our eNewsline):

June 2024, Pharmacy Owner’s Involvement in Fraud Scheme Leads to 4-Year Prison Sentence
December 2023, Unveiling a Multi-Million Dollar Fraud and Kickback Scheme
April 2023, Black Market HIV Medications Are Not Worth the Savings!
January 2023, Valid Prescriber/Patient Relationships and Marketing Concerns
November 2022, OIG Telehealth Fraud Concerns
November 2021, Stark Law and Anti-Kickback Violations –Indictments Handed Down for Medically Unnecessary Claims
January 2021, Foot Baths Continue to Be Focus of Audits and Recoupments

Author
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Eric Hartkopf, PharmD

Analyst at PAAS National^®

As an Analyst, I focus on providing pre- and post-audit assistance, answering various member service questions, and researching & drafting articles for the Third-Party Newsline. I work with many of our members involved with invoice audits.

I obtained my PharmD from the University of Wisconsin-Madison School of Pharmacy and worked for a major chain as well as various LTC and independent pharmacies, before coming to PAAS.

I am passionate about learning and teaching. I strive to learn something new about PBM audits every day, so that PAAS can be more knowledgeable to better serve our members! In 2018, I started traveling to state pharmacy conferences to present audit seminars and meet our wonderful members in person.

Latest posts by Eric Hartkopf, PharmD (see all)

U.S. Government Alleges Counterfeit HIV Drugs Hiding in Pharmacy-to-Pharmacy Purchases - November 6, 2024
Walgreens $107 Million Settlement for False Claims Act Violations - November 4, 2024
Audit Risks: Medication Home Delivery - October 19, 2024