In September of this year, the New York Attorney General recoup nearly $250,000 in restitution to resolve a Medicaid fraud case involving the misdeeds of a former pharmacist for Tops Market Pharmacy, headquartered in Williamsville, New York.
One of the pharmacists employed by Tops Market Pharmacy had been suspended from practice and excluded from the Medicaid program, but nonetheless was continuing to dispense prescription medications at the pharmacy. The excluded pharmacy pleaded guilty to defrauding the Medicaid program of approximately $187,500. However, as part of the agreement, the pharmacy was required to pay nearly $250,000 in restitution to the State for amounts billed to Medicare and Medicaid for prescription medications fraudulently dispensed by the excluded pharmacist.
New York’s Attorney General, and the Attorney Generals of the other States, are making it clear that they are committed to recouping taxpayer dollars and stepping up strict enforcement on “excluded providers.”
“Excluded providers” consists of any individual or entity that provides or is involved in the provision of, or billing for, services or items that are reimbursable by Federal and/or State health care programs who has been excluded from participation in those programs. These providers can be physicians, nurses, nurses’ aides, DME companies, physical therapists, pharmacists, billing companies and non-licensed persons involved in some aspect of the health care industry. Individuals and entities can become “excluded providers” for any number of reasons, most frequently for license suspension or revocation, or for program-related convictions.
As is demonstrated by the recent actions of the New York Attorney General, it is important for healthcare practices to regularly verify that no employee or vendor is excluded from participation in federal health care programs. Contact us today to speak to an attorney.
