The Department of Health and Human Services has been vigilant in detecting possible instances of health care fraud. About a week ago, the agency announced that more than 400 individuals were charged with committing health care fraud. The alleged fraudulent billing practices from those charged exceeded $1.3 billion.
Two of the people facing charges are from Mississippi. Both of the men’s fraud charges stem from activity conducted with TRICARE.
One man, a pharmacist at Advantage Pharmacy, is being charged with conspiracy to defraud the federal government. This charge stem from allegations that the man attempted to defraud TRICARE and other health care benefits programs by dispensing prescriptions that weren’t medically necessary.
The second man, a health care marketer, has been charged with attempt and conspiracy. He is being accused of receiving kickbacks from a pharmacy in exchange for persuading doctors to prescribe more than $2.3 million in drugs paid for by TRICARE.
Both men are expected to plead guilty to the charges.
The moral of this story is twofold. First, the federal government is extremely committed to tracking down possible instances of health care fraud. Health care professionals need to ensure they’re following the proper procedures when billing TRICARE and other government-managed health care programs.
Second, health care professionals need to be diligent about doing their best to help prevent fraud in their workplace. Good practices that should be followed include:
- Ensuring all staff members are fully educated about the forms and procedures used when billing government-managed health care programs
- Establishing clear and comprehensive billing procedures and policies
- Creating internal standards for billing practices and enforcing these standards when necessary
There could be significant penalties looming for those facing health care fraud charges. That’s why it’s so important that those being accused take these allegations seriously and develop a robust plan to deal with those charges.