Question

Fraud alerts are common practices following federal investigations. Complete a search of the Resources area of the Health Care Compliance Association website OR search the internet for a recent fraud case or fraud alert in health care.

Create a fact sheet about the fraud case you choose. A fact sheet provides the basic information in an outline format. Feel free to use graphics in a creative manner.

You may choose to use one of the many fact sheet on the internet.

Include:

·         The specific fraud alert (2 points)

·         What legislation may be violated (3 points)

·         The organization(s) involved (2 points)

·         The main points of the fraud (5 points)

Provide references for any site used to find information for your fact sheet.

Answer 1

The specific fraud alert

Brooklyn pharmacy owner Sunita Kumar charged with healthcare fraud for abuse of patient prescriptions-prescription drug scam and getting Medicare reimbursements

What legislation may be violated

Health Insurance Portability and Accountability Act-

Healthcare professionals who willingly involve in schemes to receive healthcare benefit from a healthcare program, using false pretense. Penalties of upto 10 years imprisonment may be imposed. If it involves serious injury, 20 years or life imprisonment can be imposed

False Claims Act

Lays penalties for submitting false claims to Medicare or Medicaid

The organization(s) involved

• Brooklyn Pharmacy Owner –Sunita Kumar

Investigating organizations

• The Office of Inspector General (part of the Department of Health and Human Services which conducts nationwide audits, and inspections.
• The Department of Justice( including the Federal Bureau of Investigation and US Attorney offices
• State Medicaid fraud control units

The main points of the fraud

Pharmacy owner, Sunita Kumar obtained prescriptions from Brooklyn’s poor in exchange for money.she submitted approximately $9 million in claims to Medicaid and Medicare for medicines that were not actually dispensed. She did this through two pharmacies in Brooklyn. The proceeds from the reimbursements were used to pay a share for the prescription owners