Health Care Fraud

In New York City, the Office of the State Attorney General, Eastern and the Southern District of New York routinely investigates pharmacies who are involved in Health Care Fraud.

Most commonly, pharmacy fraud revolves around extremely expensive medication and involves the pharmacy paying kickbacks to either patients or doctors to generate business.

The Pharmacy business relies on prescription medication scripts that are generated by the medical doctors. Many times, doctors in varies specialties forward many or all of their prescriptions to a specific pharmacy in exchange for money kickbacks from the pharmacies.  Once pharmacies receive the scripts, they may dispense diverted medications, they may not dispense the medication at all, or the pharmacies may even buy back the very expensive medication for a small modest fee.  Unfortunately, all of these acts are a violation of New York penal law on the state and federal level.

At the Law Office Of Boris R. Nektalov, we understand that no two cases are alike and that these alleged schemes have many participants, some of whom lack any knowledge of the criminal acts being committed by a few and are totally innocent.

Most of the time, health care fraud investigations are long term and may involve interactions with law enforcements on many different occasions. This is not unusual as it is difficult to unravel the fraud because many pharmacies employ many people who are technicians, pharmacist, and delivery people and are run by owners who are either active or silent partners.

Most typical cases today involve sting operations with law enforcement utilizing  confidential informant who are prescribed HIV medication, who then appear physically at the pharmacy to pick up their medications and request to sell back their medication to the pharmacy for money, many times a small fraction of what the drugs actually cost the pharmacy. These buy back schemes are sometimes masked as donations and the pharmacies continue to bill Medicaid or Medicare for the medication without ever dispensing the drugs to the patient, while you continue to be a victim of the schemes.

What is typical in many of these cases is that some pharmacy owners have very little day to day supervision and the fraud transpires behind their backs by the pharmacists or other, more active owners who run the pharmacies on a daily basis without their knowledge.

If you are audited or are asked to come in for questioning pertaining to a healthcare audit, you may be a target of a criminal investigation and should not engage law enforcement without the assistance of a criminal defense attorney.

If you have been arrested and charged with various health care frauds, money laundering, wire fraud and a violation of the anti kickback laws, in Queens, Brooklyn or Manhattan, contact us immediately.

Know your rights! Call the Law Office of Boris R. Nektalov today at (718) 849 7272