In recent Medicaid abuse lawsuit, a New York pharmacist and three of her pharmacies are facing major whistleblower allegations against the state’s Medicaid program.

According to the Medicaid abuse lawsuit, the pharmacist defrauded millions out of the program that she spent on various luxuries such as plastic surgery procedures and traveling. Pharmacist Hin T. Wong is named as the primary defendant in this Medicaid abuse lawsuit, along with NYC Pharmacy Inc. and New York Healthfirst Pharmacy Inc.

Wong and her pharmacies allegedly offered patients kickbacks for their medication prescriptions, including expensive HIV treatments, which were later billed to Medicaid for refills even though no medication was distributed.

Wong allegedly also paid cash to these these patients, for referring other Medicaid patients to her.

Overview of Medicaid Abuse Lawsuit

An ongoing investigation into NYC Pharmacy allegedly exposed this practice which was conducted by the attorney general’s Medicaid Fraud Control Unit. Since July 2014, Wong allegedly had paid kickbacks to undercover agents for the attorney general that were posing as patients.

Wong reportedly asked patients to fill their prescriptions at the pharmacies she owned and primarily used HIV medication prescriptions that totaled over $2,000 in monthly payments. These would then be billed to Medicaid.

“Stealing from Medicaid in order to purchase fancy accessories and travel tickets is absolutely shameful. [W]e will not allow Medicaid to serve as a personal piggy bank for criminals. Fraudsters who seek to rip off this vital program that helps millions of New Yorkers will be held accountable,” the attorney general said in a press release.

Wong reportedly hid the kickback scheme by transferring “hundreds of thousands of dollars” between the pharmacies’ bank accounts, her own bank account, and into an additional account in Canada. As part of the Medicaid abuse lawsuit, the attorney general stated he obtained a court order freezing the defendants’ accounts.

The attorneys involved in this Medicaid abuse lawsuit had filed a separate civil asset forfeiture action suit against Wong and her three pharmacies, seeking over $11 million in damages. This additional claim alleged the defendants had billed Medicaid and other insurance company over $15 million for other medications.

Wong was reportedly arrested and charged with grand larceny and paying illegal kickbacks to a medical assistance provider. With bail set at $500,000, Wong may potentially spend up to seven years in state prison.

Healthcare billing fraud is one of the most common forms of fraud the federal government faces, with Medicare or Medicaid patients never receiving the coverage they need. While this form of fraud can occur in a number of ways, fraudulent medical billing is one of the most often reported.

This Medicaid abuse lawsuit may encourage other whistleblowers to come forward, and report fraud they witnessed to proper authorities. In order to be considered a whistleblower, the claimant must be the primary source of the allegations and cannot receive information from a secondary source.

In exchange for their cooperation, whistleblower will typically be rewarded 15% to 30% of any settlement the lawsuit recovers.

This Medicaid Abuse Lawsuit is Case No. 2017NY045090 in New York Criminal Court, New York County.