A pharmacy owner pled guilty to Medicare and Medicaid fraudcharges in federal court located in Manhattan.

According to a DOJ press release, Sajid J., the named defendant, admitted to submitting over $8.5 million in claims for prescription medication he never dispensed from any of his pharmacies.

The Medicare and Medicaid fraud was purportedly perpetrated by luring patients with valid doctor prescriptions into foregoing their needed drugs in exchange for money or gifts purchased with proceeds from the scheme.

A federal attorney working for the U.S. District Court for the Southern District of New York, Geoffrey S. Berman, admitted that the way in which this Medicare and Medicaid fraud was undertaken put the involved patients at severe risk.

Additionally, in the DOJ statement, Berman noted that this Medicare and Medicaid fraud—part of a larger sting on the part of the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services Office of Inspector General (HHS OIG)—contributed to a multi-billion dollar theft of the federal government.

The Details of the Fraudulent Activity

The DOJ press release says that Sajid had nine pharmacies that he both owned and operated in the two boroughs. The fraudulent claims were allegedly submitted between the first month of 2013 and mid-summer 2015.

During this time window, Sajid was allegedly able to obtain several million dollars in claim payments from the Medicare and Medicaid programs.

He took the money obtained and used it to enrich himself and to pay kickbacks to those patients that chose to forego their medication regimen in exchange for money, according to the DOJ. The press release said he paid the promised portion to patients in order to keep the defrauding scheme active.

Sajid is 47 years old and resides in Fresh Meadows, Queens. He pled guilty to one count of conspiracy to commit health care fraud. He is expected to be sentenced on August 24, 2018 and will serve up to five years in prison.

U.S. Congress established a five year incarceration penalty is the maximum for the associated crimes, but within this parameter the presiding federal judge is allowed discretionary powers.

The Medicare Fraud Strike Force brought charges against over 300 people for engaging in similar Medicare and Medicaid fraud schemes in 2016. In a flurry of activity, the nationwide sting sought to bring to justice perpetrators that had defrauded public health to the tune of $900 million. Sajid was part of this sting and was arrested at that time.

The False Claims Act

If you suspect an employer of committing fraud against a public health program, you may be able to file a legal action on the part of the United States government. Under the terms of the False Claims Act, citizens who do this are called relators and can receive a portion of reclaimed funds if the government chooses to participate in the litigation.