In a recently filed whistleblower lawsuit, a pair of Philadelphia pharmacy owners agreed to pay $3.2 million to resolve serious allegations of Medicare false billing. The whistleblower lawsuit settlement was struck between the pharmacy owners and the federal government, after an investigation revealed alleged cases of Medicare false billing.

The defendants named in the whistleblower lawsuit are Irina Minkovich and Yelena Babchinetskaya, the owners of the I&L Express Pharmacy, who signed the settlement to resolve the Medicare false billing allegations. According to the whistleblower lawsuit, the alleged occurrences of Medicare false billing had begun in 2009 and lasted until 2015.

The settlement deal was reportedly proposed after the investigation had concluded. Under the terms of the settlement, the pharmacy owners face no civil or criminal charges for the alleged Medicare false billing. These occurrences of allegedly Medicare false billing reportedly pertained to prescription medication that was never provided to the designated recipients.

The whistleblower lawsuit alleged the pharmacists had falsely billed Medicare for medications were never provided and cost taxpayers money. The federal government stated that this settlement is important, as it resolved another case of healthcare fraud. In addition, the whistleblower lawsuit notes that these pharmacists acted in their own best interest and not their customers.

“Pharmacies are an integral partner in patient care, and they are expected to act with integrity,” said Maureen Dixon, special agent in charge of the Philadelphia Regional Office of the U.S. Department of Health and Human Services, Office of the Inspector General, in a statement.

Overview of Medicare Healthcare Fraud

Healthcare fraud is one of the most significant forms of fraud against the federal government, often involving Medicaid or Medicare false billing. More specifically, this fraudulent billing often involves billing the government for medically unnecessary services or drugs that the patient never received.

Medicare and Medicaid fraud is typically committed by hospitals, physicians, pharmacies, and other healthcare companies billing the federal government for medical goods and services. It is important to note that other forms of healthcare fraud can occur at any time including:

• Deliberately upcoding medical billing for more expensive goods or services
• Overcharging for medical goods or healthcare services
• Illegal kickback arrangements between healthcare providers and physicians for patient referrals
• Billing for services not medically necessary
• Sending in claims for medical services that are supposed to be provided by a physician, when the care was provided by a less qualified employee
• An ambulance company entering kickback arrangements with hospitals, or claiming emergency services for non urgent transport

Healthcare fraud or any other form of fraud against the federal government, can be reported by an employee or other individuals. People who report this fraud are called whistleblowers and are largely responsible for uncovering fraud schemes. For their participation, whistleblowers can receive between 15 to 30 percent of whatever settlement is recovered.

In addition, companies accused of the alleged fraud have the opportunity to pay a settlement to avoid any further criminal or civil charges. This was reportedly the case for Minkovich and Babchinetskaya, in which the settlement will resolve the Medicare billing fraud allegations after the settlement is paid.