A Miami-area
pharmacy owner,Tamara Esponda, was sentenced November 17, 2015 to 42
months in prison for her role in the submission of more than $1.5 million in
fraudulent claims to Medicare Part D. This was a case of ghost billing -
billing for drugs that were not prescribed or provided to patients.
This
is the kind of black and white case that one expects in health care fraud and is not one that
involves complex regulatory issues. This also involves identity theft issues
where there is billing of patients' Medicare without their consent. Miami, Los Angeles, and New York continue to be the areas with the most health care fraud prosecutions.
This
case was resolved by a plea agreement and Ms. Esponda pleaded guilty to one
count of health care fraud on Aug. 7, 2015. In addition to imposing the prison
sentence, U.S. District Judge James I. Cohn of the Southern District of Florida
ordered Esponda to pay $1,583,976 in restitution.
Ms.
Esponda owned Biomax Pharmacy Inc. According to admissions made in connection
with her guilty plea, between October 2012 and September 2013, Biomax Pharmacy
submitted fraudulent claims to Medicare for prescription drugs that were not
prescribed by physicians, not medically necessary and not provided to Medicare
beneficiaries.
Ms.
Esponda further admitted that in perpetrating this fraud she and her
accomplices used the beneficiaries’ and doctors’ Medicare identification
numbers without their consent. During the course of the scheme, Biomax received
more than $1.5 million in payments from Medicare Part D, the prescription drug
benefit, based on those false claims.
Posted by Tracy Green, Esq.
Office - 213-233-2260
Email: tgreen@greenassoc.com
