Corporate Compliance

Business illegally obtains OxyContin perscriptions, bills Medicare

Compliance Monitor, June 10, 2009

On June 4, the U.S. Department of Justice (DOJ) unsealed the grand jury indictment that charges a medical business owner and 10 co-conspirators with a healthcare fraud scheme used to illegally obtain OxyContin for sale on the streets, all while charging Medicare.

 “The indictment exposes a highly organized and sophisticated scheme to obtain millions of dollars-worth of potent prescription pain killers, sell them on the street, and stick the U.S. taxpayer with the bill by illegally charging Medicare,” United States Attorney Terrence Berg said in the release.

According to a DOJ release, between January 2007 and December 2008, George Williams, owner and operator of Quick Response Medical Professionals, P.C., a healthcare business based in Detroit, recruited Medicare beneficiaries to be patients at his business by paying them $220 cash per visit. During the medically unnecessary doctor visits, patients would undergo medical tests in order to obtain a prescription for OxyContin, according to the DOJ.

The DOJ alleges the patients did not receive the prescription, but instead, Quick Response employees kept the prescription and had it filled by pharmacy employees who were in on the scheme.

The DOJ alleges the conspirators then sold the pills on the street and billed Medicare for the doctor visit and the tests. Authorities believe the scheme produced 200,000 dosage units of OxyContin with an estimated retail market value of $5 million. Quick Response also received an estimated $480,000 in improper Medicare reimbursement in 2008.

If convicted, the defendants face a long sentence. A conviction on charges of the controlled substance conspiracy carries a maximum penalty of 20 years in prison, a $1 million fine, or both. A healthcare fraud conviction carries a maximum penalty of 10 years in prison, a $250,000 fine, or both. And a conviction of making unlawful payments to the Medicare beneficiaries could add another 5 years in prison (the maximum), a $250,000 fine, or both.

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