By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
A pharmacy in New Jersey, Cross Roads Pharmacy, agreed to pay over $1.9 million to resolve allegations of its overbillling the Medicaid Program. According to the Office of the State Comptroller, more than 3,800 claims were submitted by the pharmacy without records to back up the claims.
A Three Year Investigation.
After a three-year investigation by the office’s Medicaid Fraud Division, it revealed that Cross Roads Pharmacy submitted 3,887 claims for pharmaceutical products. These products were allegedly given to Medicaid patients, but the pharmacy did not have purchase records for them, leading up to nearly $3.1 million in overpayments.
It was also revealed that Narendar Yasa, the owner of the pharmacy, did provide documentation for some of the claims, reducing the overpayment total by almost $1.2 million. According to the division, “It is essential for all Medicaid providers to keep proper documentation in order to be reimbursed by Medicaid. The agreed upon corrective action plan provides a roadmap for Cross Roads to come into compliance.”
According to the settlement, the division conducted an inventory analysis for the pharmacy during 2011 to 2014. It revealed many instances where the pharmacy billed Medicaid and managed care organizations without having the supporting documentation of wholesaler invoices. State law requires Medicaid providers to retain supporting documents in order to receive reimbursement from the Medicaid Program.
The agreement also included a corrective action plan, laying out areas wherein the pharmacy didn’t comply with Medicaid requirements and detailing ways to resolve those issues. Additionally, Cross Roads is required to designate a coordinator to monitor compliance with the plan to ensure that proper documentation is retained.
To read the settlement in this case, click here.
Click here to read one of my prior blogs on a similar case of Medicaid overbilling.
Medicaid Fraud is Serious.
When a pharmacy receives an audit notice or a subpoena for records, it is crucial that they immediately retain an experienced heal lawyer to assist them in responding so as to help avoid the type of situation in the report.
If the state Medicaid Fraud Control Unit (MFCU) shows up with a subpoena or a search warrant, then it is even more serious because then you know that a criminal investigation is being conducted.
Contact Health Law Attorneys Experienced in Handling Medicaid Audits, Investigations and other Legal Proceedings.
Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health law attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
The Health Law Firm’s attorneys routinely represent physicians, dentists, orthodontists, medical groups, clinics, pharmacies, assisted living facilities (AFLs), home health care agencies, nursing homes, group homes and other healthcare providers in Medicaid and Medicare investigations, audits and recovery actions.
To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.
Posses. Shayna. “NJ pharmacy pays $1.9M for alleged Medicaid overbilling.” Law360. (March 22, 2016). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.
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