Kusserow’s Corner: Pharmacy Fraud

Several recent blog articles at this site focused on the growing problem of abuse in the pharmaceutical drug market place. Some of the articles spoke to specific enforcement actions. The issue was the subject of a hearing before the Senate Committee on Homeland Security where the HHS Office of Inspector General (OIG) testified on “Curbing Prescription Drug Abuse Drug Abuse in Medicare.” They noted there were now approximately $67 billion in annual expenditures and over 37 million beneficiaries related to the Medicare drug benefit. The witnesses described how the various federal and state enforcement agencies were organizing to address the growing problem of fraud related to the program. A significant portion of the testimony related fraud committed by pharmacists. They cited findings from their reviews of extreme prescribing patterns involving hundreds of physicians and questionable billing by thousands of pharmacies. In their review of the Part D program they found tens of millions of dollars expended to pay for prescriptions order by counselors, social workers, chiropractors, nurses, physical therapists, occupational therapists, and speech language pathologists, as well as tens of thousands of improper prescriptions for controlled substances.

We were recently reminded of the problem, when Delmer Holmes Parrish, a licensed pharmacist, and Patricia Parrish, of Naples Florida, pleaded guilty to conspiracy to commit health care fraud of approximately $351,358.14 and face a maximum penalty of ten years. They used Sunshine Pharmacy and Sunshine Solutions to submit and cause claims to be submitted for reimbursement from Medicaid, Medicare, and TRICARE programs for prescriptions, not filled or provided to beneficiaries and recipients. The claims included prescriptions for patients that had not been written or authorized by any duly licensed physician. In addition, the co-conspirators submitted and caused claims to be submitted for reimbursement from these same programs for beneficiaries and recipients who were deceased. In furtherance of the fraud scheme, they also used the means of identification of individuals who were enrolled in the Medicaid, Medicare, or TRICARE programs, without their knowledge or consent. In addition they perform acts and made statements to hide and conceal the scheme. They agreed to pay restitution. As part of the agreement, Delmer Holmes Parrish has also agreed to voluntarily relinquish his pharmacist license to the State of Florida. A sentencing date has not yet been set.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on Google+ or LinkedIn.

Copyright © 2013 Strategic Management Services, LLC. Published with permission.