Rx for Fraud: Health care fraud issues
The numerous "patients" of Dr. Alvin Mingczech Yee could obtain illegal prescriptions from him as easily as ordering a sandwich. In October 2011, Yee, a licensed physician from Mission Viejo, California, was arrested for selling prescriptions for Oxycontin, Vicodin and Xanax at a local coffee shop for $100 each. Yee faced a 56-count grand jury indictment of prescribing drugs "outside the usual course of professional practice and without a legitimate medical purpose." (See
Prosecutors: Doctor prescribed drugs at Starbucks, by Vik Jolly, Oct. 26, 2011, updated Aug. 21, 2013, The Orange County Register.)
Numerous schemes like this are fueling a growing prescription drug fraud epidemic that's affecting the health care system.
According to the Centers for Disease Control and Prevention (CDC), U.S. nonmedical use of prescription painkillers results in more than $72.5 billion annually in direct healthcare costs. (See
Prescription Painkiller Overdoses in the U.S., CDC.)
In President Obama's April 25, 2011, action plan to reduce prescription abuse — "Epidemic: Responding to America's Prescription Drug Abuse Crisis" — he identified prescription drugs as the second most-abused category of drugs after marijuana. In addition, the U.S. Department of Justice Office of Inspector General (OIG) has released several reports on prescription drug fraud in the Medicaid and Medicare Part D populations.
This epidemic has not only led to an increase in prescription drug fatalities, it's also fueled opportunities for prescribers, pharmacies, patients and recruiters to fraudulently reap billions of dollars.
WHO ARE THE OFFENDERS?
These fraudsters have many faces: patients, patients' family members, prescribers, pharmacy staff, medical employees, service contractors, recruiters and countless others are involved in prescription drug fraud schemes.
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