Thursday, November 19, 2015

Miami-Area Pharmacy Owner Sentenced to 42 Months in Prison for Role in $1.5 Million Medicare Part D Fraud Scheme

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.

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