Compounding pharmacy fraud cases are really being targeted and cracked down on across the USA. Yet another major fraud case centered around a compounding pharmacy billing Medicare, TRICARE (the military’s healthcare program) and private insurance programs has been resolved finally, once again drawing the pharmacy profession into the national news spotlight in a very negative way.
A To Z Pharmacy and Compounding Pharmacy Fraud Scheme
After six other individuals were already convicted and sentenced for their roles in the one-hundred million dollar ($100,000,000) fraud case, Nicholas Borgesano Jr., the owner of A to Z Pharmacy that was located in New Port Richey, Florida was finally sentenced this past week. Borgesano was convicted for fraud and his punishment was both a fifteen year prison sentence plus restitution of over fifty-four million dollars ($54,000,000) to be repaid. The compounding fraud operation also involved six other pharmacies that were located in both Miami and Hialeah Florida. Additionally, several real estate properties were seized, along with Borgesano’s cars and his Cigarette racing boat.
Who Was Involved
Along with A to Z Pharmacy in New Port Richey, the following South Florida pharmacies and drugstores were also utilized as a part of the fraud scheme:
– Havana Pharmacy, located in Miami
– Medplus Pharmacy, located in Miami
– New Life Pharmacy, located in Miami
– Metropolitan Pharmacy, located in Miami
– Jaimy Pharmacy, located in Hialeah
– Prestige Pharmacy, located in Hialeah
Along with Borgesano, the other guilty defendants that were already previously convicted and sentenced for participating in the illegal fraud scheme were:
– Scott Piccininni, from Ft. Lauderdale, Florida, who received a 51 month prison sentence
– Edwin Young, from New Port Richey, Florida, who received a 66 month prison sentence
– Matthew Sterner, from New Port Richey, Florida, who received a 36 month prison sentence
– Peter Williams, from New Port Richey, Florida, who received a 26 month prison sentence
– Bradley Sirkin, from Boca Raton, Florida, who received a 46 month prison sentence
– Joseph Degregorio, from New Port Richey, Florida, who received a prison sentence of one year and one day
Interestingly, there is still one more conspirator (Wayne Kreisberg, from Parkland, Florida) who is still awaiting sentencing that is scheduled to be announced this coming Monday (April 30th).
The Compounding Fraud Scheme
As with most other recent cases of compounding pharmacy fraud, the scheme that centered around Borgesano involved submitting both fraudulent and totally bogus prescriptions for insurance reimbursements. Private insurance providers, plus both Medicare and TRICARE were the victims for paying over $100,000,000 to the pharmacies involved. Basically, the conspirators altered and/or manipulated the billing codes for the bogus claims, plus even billed the insurance companies for prescriptions compounded with ingredients that the pharmacies never even actually had.
Additionally, the defendants bribed a local doctor to increase the volume of bogus prescriptions that they could submit to the insurance companies for reimbursement. The bribes to the physician were for him signing Rx’es for patients that were never actually seen by him. They also paid kick-backs to others for what is known as “patient identifying information” that allowed them to target potential patients and recruit them into using their pharmacies and services.
More Pharmacy Fraud Cases Coming?
Several highly placed government officials and members of the FBI team that investigated the case have hinted that this case may be just “the tip of the iceberg”. Since the inception of what is known as the Medicare Fraud Strike Force a decade ago, over three-thousand five-hundred individuals have been convicted of compounding fraud schemes. The Strike Force operates on a national level and has so far identified an astonishing twelve and a half billion dollars in fraudulent claims to Medicare alone.
Overseen by both the Department of Justice and the Department of Health and Human Services, the Medicare Fraud Strike Force utilizes the “data-analysis capabilities of the Centers for Medicare and Medicaid Services, the investigative resources of the FBI, and the prosecuting resources of the Department of Justice and the U.S. Attorneys’ Offices”. Although a nationwide team that operates on a national level, the Strike Force has nine regional operating centers:
– Tampa, FL
– Miami, FL
– Los Angeles, CA
– Brooklyn, NY
– Detroit, MI
– Chicago, IL
– Baton Rouge, LA
– Houston, TX
– Dallas, TX
HCC Can Help Compounding Pharmacies
If you currently own or operate a compounding pharmacy, or are planning a new compounding pharmacy startup, Healthcare Consultants can help you. HCC has helped more compounding pharmacies with compliance issues and helped open more new compounding pharmacies than any other pharmacy consulting firm in the nation.
Now is the time to ensure that you are doing everything correctly and legally. Contact us here at HCC if you have any questions regarding operating a compounding pharmacy. With over 28 years in the Pharmacy Consulting business, HCC can assist with expert advice in any area of your pharmacy business or practice. With a full-time staff of in-house Pharmacy Consultant specialists, HCC can answer any questions that you may have in all areas of your business. Call us today at 800-642-1652 or contact us now online for a free consultation.