Video taken by an undercover government informant shows a woman, her son and husband wiping labels off prescription medication bottles in a South Florida apartment. They use lighter fluid to remove the labels, then reattach the Information packet to the bottles that contain expensive medication including HIV meds that patients chose to sell.
Fernando Porras, assistant special agent in charge with the U.S. Department of Health and Human Services’, Office of Inspector General (HHS OIG) says the practice of skipping your HIV meds to sell them is dangerous. “Their viral levels could increase, and they could potentially infect a partner or the population…And for patients that consume medications that were stored under perhaps not the best of conditions, it may affect the quality of the medication,” says Porras.
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HHS OIG says drug diversion is just one of the ways criminals steal billions of dollars from Medicare each year. “Unfortunately South Florida is the epicenter of Medicare fraud,” states Porras.
Drug Diversion Works like this: A patient picks up a prescription valued at thousands of dollars and sells it to an aggregator for a fraction of the price. The buyer, known as an aggregator, removes the label and sells it to a wholesaler who then sells it back to a pharmacy at a discount. “A pharmacy could easily bill the Medicare program two and three million dollars doing this scheme,” Porras says.
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The family from the video was found guilty and served 2-to-3-year prison sentences for Defrauding the United States and Engaging in the Unlicensed Distribution of Prescription Drugs.
In another case, Lázaro Hernández pleaded guilty to running an elaborate scheme to distribute more than $230 million dollars’ worth of adulterated and misbranded prescription drugs and sentenced to 15 years behind bars. “Weoften hear about providers, owners of clinics or medical facilities being arrested or indicted. And unfortunately, we've arrested a lot of doctors as well…but it's not uncommon for us to arrest beneficiaries as well for being on the take,” says Porras.
HHS OIG stresses it’s important to be on the lookout for these types of schemes. The fraud usually happens when someone bills Medicare for unnecessary equipment, treatments, or prescription drugs. It can also happen when someone offers to pay a Medicare beneficiary to enroll in a program or treatment they don’t need or calls them claiming they are from Medicare and want to send them a free genetic test.
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To combat Medicare fraud, HHS OIG asks beneficiaries to be thorough. “We ask them to review their explanation of benefits, although it says it's not a bill, it potentially could indicate whether there's fraudulent activity in their account,” Porras explains. He says if you see fraudulent activity, you should report it to Medicare immediately and if you’re having a hard time reading that document, you can ask it be sent in your language or in bigger font.
