Assignment 3.1: Health Care Crimes Analysis

Overview

Mr. Jones is a pharmacist employed by ACME Drug. He has a known drug problem and his drug of choice is Mepergan. Maria Smith is a cancer patient and customer of ACME drug company. Ms. Smith has been receiving Mepergan Fortis, a schedule II narcotic, as part of her scheduled pain treatment. The last time Ms. Smith had her prescription for Mepergan Fortis filled, Mr. Jones was the pharmacist on duty. Ms. Smith noticed that the medication was not working as it had in the past and returned to the pharmacy. The pharmacist on duty determined that the wrong medication was given to Ms. Smith, 28 Mepergan Fortis and 32 Feldene. Since the stock bottle of Mepergan Fortis remains in a locked drawer, the video was reviewed and it was discovered that Mr. Jones had transferred the Feldene capsules into the Mepergan Fortis bottle, and put the Mepergan Fortis capsules in his pocket. The amount charged to Missouri Medicaid for the Mepergan Fortis prescription for Ms. Smith was $117.00. The amount that would have been charged to Missouri Medicaid for the Feldene that was dispensed would have been $8.97. Further investigation by ACME Drug revealed that Mr. Jones had likely billed for a higher cost controlled substance and dispensed a lower cost non-effective medication to more than five other patients.
Issues
One of the immediate issues is the fraudulent Medicaid billing. According to USA today, there have been 14,663 providers and suppliers who have lost their ability to bill Medicare due to fraudulent billing (Kennedy, 2013). In this case, Mr. Jones can be held personally responsible for the fraudulent billing. Once the investigation is completed and they find that Mr. Jones over charged Medicaid for medicine that their patients did not receive, he will lose his ability to bill Medicare. Depending on how