March 10, 10

NEWS / East Orange Pharmacy Technicians Sentenced for Medicaid Fraud

Medicaid program billed for expensive HIV/AIDS prescriptions never dispensed

TRENTON - Attorney General Paula T. Dow and Criminal Justice Director Stephen J. Taylor announced that two Essex County pharmacy technicians were sentenced today for participating in a scheme in which pharmacy owners and employees allegedly bought completed prescription forms for HIV/AIDS drugs from indigent patients so Medicaid could be billed for drugs that were never actually dispensed. A third pharmacy technician pleaded guilty today to illegal possession of prescription drugs.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Jannah Rasheedah Amatul Muid, 26, of East Orange, and Alicia Stephens, 29, of Newark, were each sentenced to three years of probation by Superior Court Judge Michael A. Petrolle in Essex County. The judge ordered that they be excluded from working for any Medicaid provider for five years. In addition, Muid was ordered to perform 150 hours of community service, and Stephens, 100 hours.

Muid and Stephens each pleaded guilty on Jan. 20 to third-degree Medicaid fraud, a charge contained in an Oct. 26, 2009 state grand jury indictment. In pleading guilty, the defendants, both technicians at Pharmacy of America in East Orange, admitted that between May 11, 2006 and October 15, 2008, they paid Medicaid beneficiaries for prescriptions and subsequently billed Medicaid for prescription drugs that were never dispensed to the Medicaid beneficiaries.

Deputy Attorney General Sherry Wilson prosecuted the defendants and represented the state at the sentencing hearing. The defendants were charged as a result of Operation PharmScam, an ongoing investigation targeting Medicaid fraud that began in 2008 and has been conducted by the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit, the Jersey City Police Department and the U.S. Food and Drug Administration’s Office of Criminal Investigations.

Also today, a third technician at Pharmacy of America, Shivonne Diacy Forde, 27, of Orange, pleaded guilty to an accusation charging her with third-degree unlawful possession of prescription drugs with intent to distribute.

In pleading guilty, Forde admitted that she possessed prescription cough syrup with codeine, without a valid prescription, which she intended to provide to others for distribution on the street. The state will recommend that she be sentenced to three years of probation. She will be excluded from working for any Medicaid provider for five years. Her sentencing is scheduled for June 3.

“Our Medicaid Fraud Control Unit has made it a priority to detect and prosecute dishonest pharmacy operators who view the high cost of many prescription medicines as a golden opportunity to fraudulently bill the Medicaid program,” said Acting Insurance Fraud Prosecutor Dagli. “We have indicted four pharmacists and three pharmacies in this ongoing investigation.”

Seven other defendants were indicted along with Muid, Stephens and Forde as a result of the investigation into Pharmacy of America and other pharmacies that were buying prescriptions from patients and billing the Medicaid Program for medicines that were never dispensed. A full list of defendants charged is in the Oct. 26, 2009 press release at www.njpublicsafety.com.

On Feb. 23, Nwala Gabriel, 49, of Piscataway, pleaded guilty to a charge of third-degree Medicaid fraud before Judge Petrolle. In pleading guilty, Gabriel, the owner of Harrison Pharmacy on Martin Luther King Boulevard in Newark, admitted that he fraudulently billed Medicaid for prescription drugs that were never dispensed to the Medicaid beneficiaries.

The state will recommend that Gabriel be sentenced to three years of probation. The state also reserves the right to recommend that he be sentenced to up to 364 days in the county jail as a condition of probation. Gabriel must pay restitution and a penalty totaling $178,272 and will be excluded from the Medicaid program for three years. He must surrender his pharmacy license for a minimum of three years or until he successfully completes all terms of his criminal sentence.

The investigation has been conducted for the Medicaid Fraud Control Unit by Detective Danielle Han, Detective Joseph Jaruszewski, Detective Jacqueline Latty, Detective Kevin Gannon, Sgt. Fred Weidman and Sgt. James Wrightson. Deputy Attorneys General Sherry Wilson and Debra Conrad are leading the prosecutions, with assistance from Deputy Attorney General Erik Daab, Deputy Chief of the Medicaid Fraud Control Unit, and Deputy Attorneys General William Hoyman, Cynthia Vazquez, Linda Rinaldi and Carol Stanton Meier.

The Medicaid Program, which is funded by the state and federal governments, provides health care services and prescription drugs to persons who may not otherwise be able to afford such services and medicines. The State of New Jersey administers the Medicaid Program through the Division of Medical Assistance and Health Services and through the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit, which investigates both criminal and civil Medicaid fraud and abuse in that program.

Acting Insurance Fraud Prosecutor Dagli urged members of the public who have information about suspected Medicaid fraud or insurance fraud to report it anonymously by calling the toll-free hotline 1-877-55-FRAUD

State regulations permit a reward to be paid to an eligible person who provides information that leads to an arrest, prosecution and conviction for insurance fraud.

http://www.nj.gov/oag/newsreleases10/pr20100308a.html

Tags: criminal investigation,