Pharmaceutical work requires state licensing and absolute precision on the part of medical professionals. Even a tiny error could lead to a poor outcome for a patient. Other types of mistakes could lead to criminal accusations against a pharmacist.
Pharmacy fraud is a serious issue that affects not just private health insurance companies and patients but also taxpayers via Medicare and Medicaid fraud. Some research indicates that anywhere from 3% to 10% of the billing activity involving prescription medications and government insurance programs is fraudulent. Unusual activity on the part of a pharmacist might lead to intense scrutiny that could, in turn, result in criminal prosecution.
Small mistakes could look like fraud
Pharmaceutical fraud occurs in a variety of different ways. One of the most egregious forms of fraud involves billing for a prescription not actually provided to a client. Convenient or efficient operational practices could lead to allegations of fraud in some cases.
Prepping a prescription when receiving digital documentation from a medical practice or hospital might seem like an efficient solution, but there could be complications if the patient fails to arrive to retrieve the medication. Especially if a pharmacist bills insurance immediately for filling the prescription, there could be fraud concerns if that patient eventually obtains their prescription elsewhere or never comes to pick up the medication.
Mistakes when cooperating with home delivery services or mail-order prescription plans could also lead to intense scrutiny and allegations of prescription fraud. Pharmacists, especially those operating their own small standalone facilities, often need to employ very careful business practices to ensure that they only bill for prescriptions actually acquired by patients.
They may also need to take great care when overseeing the actions of technicians and other assistants on their staff, as they might face personal liability for misconduct or errors made by those professionals. Allegations of pharmaceutical fraud could have a host of complications for a pharmacist. Obviously, the potential criminal consequences of a conviction are important to consider. A pharmacist could also be at risk of losing their professional license. They might then be unable to work in a field that requires years of specialized education and professional preparations to enter.
Understanding the connection between certain business practices and increased scrutiny for prescription fraud may benefit those trying to operate efficient and successful pharmaceutical businesses. Pharmacists who make small mistakes may put their businesses and licenses at risk. Seeking legal guidance can help to ensure that minor missteps don’t result in disproportionate consequences.
