The past few weeks have shown that fraud is committed without a thought, even by those that are empowered to protect us.
A recently retired police officer from a suburban New Jersey town was involved in a compounding scheme that landed him squarely in the forefront of the environment he worked within.
Compounding fraud schemes have more recently, been less of a sore topic for Pharmacy Benefit Managers (PBMs). Part of the reason is PBMs have gotten better at understanding the schemes, and just like their medical claims counterparts, that understanding equates to creating deterrents for fraud. As with any instance involving a kickback, however, even the most robust of tools will not be able to identify the cash payment made between unscrupulous individuals that occur behind closed doors.
This particular retired police officer put his reputation and relationships with others at risk through the fraud. We asked our own retired OIG agents about instances they were able to recall where an OIG agent went rogue and committed crimes. They related several, including bank related frauds, theft and the like; all of which resulted in federal convictions. Pensions, ability to gain government employment and many of the things that they enjoyed in life were gone. Healthcare fraud, like any other white collar crime, is one of greed. We have all identified the schemes, and have all come to realize that the schemes are the same; it is plug and play. The clowns are the same, but the circus may be different.