Insurance Fraud NEWS

Coalition Against Insurance Fraud

Pharmacist in Illinois pleads guilty to $630K billing scam

August 14, 2018, Red Bud, IL — Steven P. Gibson, 29, pharmacist and owner of Gibson’s Discount Drugs in Red Bud, pleaded guilty in federal court Aug. 14 to charges he engaged in a scheme to defraud health care benefit programs by submitting false claims for fraudulent prescription medications to Medicare, Medicaid and private insurance companies. These claims were not authorized by a physician, nurse practitioner or a physician’s assistant as required.

Gibson faces up to 10 years in prison, a fine of up to $250,000, and up to three years of supervised release on each of the two counts to which he pleaded guilty. He will be sentenced Nov. 27.

During his plea hearing, Gibson admitted that he submitted false and fraudulent claims in the names of family members and pharmacy customers for prescription medication. Gibson often selected expensive prescription medications he knew would be paid for by insurance companies including Medicare and Medicaid. One such medication was Creon, a drug used to treat chronic pancreatitis. Another such medication was Pentasa, a drug used to treat ulcerative colitis. A third medication was Hydroxychloroquine, a drug used to treat or prevent malaria.

These and other prescription medications were not authorized by any physician, nurse practitioner, or physician’s assistant and were not dispensed to any of the family members or pharmacy customers. Instead, these “make believe” prescriptions were created by Gibson for the sole purpose of generating money.

In total, Gibson received payments of over $630,000 from Medicare, Medicaid and private insurance companies.

The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General; the Illinois State Police, Medicaid Fraud Control Bureau; the Federal Bureau of Investigation; the Drug Enforcement Administration; United States Postal Inspection Service; and the National Insurance Crime Bureau. The case is being prosecuted by Assistant United States Attorney Michael J. Quinley.

Anyone who suspects he or she may know of an individual or company not complying with healthcare laws or public aid programs may report this activity to the local office of the U.S. Department of Health and Human Services, Office of Inspector General, or you may call 800-447-8477.

Source: Republic-Times

< Back to stories list