Regulations to prevent fraud are only as strong as the devotion of the individuals who are expected to follow them. When physicians have been banned from the Medicaid program due to previous incidents of fraud, it is expected that they will no longer be given the opportunity to cheat the system. Pharmacies, for example, are required to do background checks on doctors who write prescriptions that require health insurance claims to ensure that they haven’t been banned from the Medicaid program.

As revealed by Tracey Drury on BizJournals.com on May 26th, Buffalo, New York-based Vascuscript Inc. apparently thought that the rules didn’t apply to them. In her recent report, the company, doing business under the name Mobile Pharmacy Solutions, has agreed to a pay out a hefty settlement to the New York State Attorney General’s Office for their role in billing Medicaid for prescriptions from a doctor who has been excluded from participating in the insurance program.

The settlement to be paid is to the tune of almost $500,000 USD. The doctor in question, a Dr. Mikhail Strutsovskiy, has been banned from writing prescriptions that require assistance from Medicaid due to prior fraudulent claims. Evidently, Mobile Pharmacy Solutions didn’t do their due diligence to look into Dr. Strutovskiy’s past. That’s one way of observing the situation. Another is to believe that they ignored the doctor’s ban altogether.

Drury explains that the Attorney General’s investigation into the matter – which was conducted by their Medicaid Fraud Control Unit – found that Mobile Pharmacy Solutions submitted and received payments for no less than 4,600 claims between April 2010 and January 2013. The claims were all made based on prescriptions issued by Dr. Strutsovskiy. Appropriate steps to take prior to filing the claims would have included verifying whether or not the doctor’s services were eligible for reimbursement. Clearly, they were not.

The exact settlement with the New York State Attorney General’s Office is for $442,000 USD, explains Drury. Mobile Pharmacy Solutions, which operates from facilities in Cheektowaga as well as on the Buffalo Niagara Medical Campus as part of the Mobile Healthcare Connections Inc. collaborative, must also pay an additional $36,000 USD in damages to the New York False Claims Act.

It’s truly unfortunate that incidents of fraud seem to continue to be so rampant in the medical world. Just a couple of weeks ago, we blogged about the fact that Medicare scams have cost American taxpayers upwards of $14 billion. Clearly, health insurance fraud doesn’t just impact Medicare and Medicaid. Hard-working Americans are being taken advantage of by those who choose to ignore fraud prevention mandates.

The Allegiant Experts team works to bring those who perpetuate fraudulent claims to justice by offering our medical expertise in court hearings that address them. For information on how our clinical experts can help your legal battle to put a stop to those who abuse our healthcare system, please don’t hesitate to contact us at 407-217-5831.