Licensed Pharmacist indicted for fraudulent billing of antipsychotic medication clozapine and sedative alprazolam to people who had already died. Costs to Medicare, Medicaid Millions

Nabil Fakih, a licensed pharmacist, Michigan Board of Pharmacy member, and owner of a Dearborn Heights drug store, was charged with healthcare and wire fraud and indicted by a grand jury. The Indictment accused Fakih of wrongfully taking millions of United States dollars from Medicare, Medicaid and Blue Cross Blue Shield (BCBS), dating back to 2011.

According to the indictment, Fakih is accused of falsely submitting claims on behalf of Dial Drugs. He was reported to be overbilling Medicaid and Medicare by $569,670 while overcharging BCBS by $558,079.

Fakih and others billed insurance companies for prescription drugs such as the antipsychotic medication, clozapine, and the sedative alprazolam. Claims for these drugs were on behalf of people who had died prior to the claimed date of delivery. This is according to government allegations.

$3.7 million was defrauded from Medicare and Medicare, while $1.4 million was taken from BCBS through their pharmacy benefit managers such as CVS Caremark and Express Scripts.

“I’m fairly confident that this criminal prosecution is more or less an outgrowth of a State Medicaid audit which exploited a newly-approved process of ‘invoice-only’ auditing,”, stated James Burdick, Fakih’s lawyer, in an email. He added, “The problem with that is that small pharmacies are unable to maintain digitized records of purchases like the big chains can do.”.

His defense is mainly dependent on the idea that small drug stores are more prone to informal means of record-keeping, and that considering this case goes back many years, it is unreasonable to require hard personal and business records in order to prove his innocence.

Burdick claims a number of wholesalers keep their invoice records for about three years, but that the audit is for 5 ½ years back. There is also the factor that informal purchases of stock without a strict need for paperwork was only prohibited recently in his state. He believes signature logs should be enough to demonstrate that every patient properly received their prescriptions.

The ruling is still out as the Department of Justice continues to look into Fakih’s case.

Healthcare fraud is one of the most dangerous and harmful as it impacts an already very fragile system that is necessary for many. The positive is that the U.S. is highly aware of this threat and has buckled down on regulating, locating, and enforcing fair punishments when it comes to those who attempt to cheat the healthcare system.

Those who are interested in learning more information about cases like this, or who want to keep up-to-date on the latest legal proceedings, check out the Newman & Shapiro Whistleblower Help Center and blog!