Thursday, April 22, 2010

New Jersey Sentences Medicaid Fraud

Essex County Pharmacy Owner Sentenced in Medicaid Fraud Investigation
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 the owner of a Newark pharmacy was sentenced today in connection with an investigation into pharmacy owners and employees who bought completed prescription forms for HIV/AIDS drugs from indigent patients so Medicaid could be billed for drugs that were never actually dispensed.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Nwala Gabriel, 49, of Piscataway, was sentenced to three years of probation by Superior Court Judge Michael A. Petrolle in Essex County. Judge Petrolle also ordered Gabriel to pay $178,272 in fines and restitution and to serve 150 hours of community service. Gabriel will be excluded from the Medicaid program for three years. He must surrender his license to practice pharmacy for a minimum period of three years or until he successfully completes all terms of his criminal sentence.

The sentence was based on Gabriel’s guilty plea to Medicaid fraud. The charge was contained in a state grand jury indictment obtained by the Office of the Insurance Fraud Prosecutor’s Medicaid Fraud Control Unit on Oct. 26, 2009.

In pleading guilty on Feb. 23, 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.

Deputy Attorneys General Sherry Wilson and Debra Conrad represented the Office of the Insurance Fraud Prosecutor at today’s sentencing.

Gabriel was charged as a result of Operation PharmScam, an ongoing investigation targeting Medicaid fraud that began in 2008 and has been conducted by OIFP’s Medicaid Fraud Control Unit, the Jersey City Police Department and the U.S. Food and Drug Administration’s Office of Criminal Investigations.

On Oct. 26, 2009, a total of 11 defendants, including Gabriel, were indicted as a result of the investigation into 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 Jan. 19, two technicians at Pharmacy of America who were indicted, Jannah Rasheedah Amatul Muid and Alicia Stephens, pleaded guilty to Medicaid fraud. On March 8, Muid and Stephens were sentenced to three years probation, ordered to pay a $1,000 civil fine and were barred from participating in the Medicaid Program for a period of five years. Muid was ordered to perform 150 hours of community service, while Stephens was ordered to perform 100 hours community service. On the same day, Shivonne Forde, another Pharmacy of America technician, pleaded guilty to third-degree possession with intent to distribute prescription legend drugs. Forde’s sentencing is scheduled for June 3.

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, who is 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.

Anyone with information about fraud or abuse involving the Medicaid program or Medicaid providers is urged to call the Medicaid Fraud Control Unit toll free at 1-877-55-FRAUD or report it online at www.NJInsuranceFraud.org. All information received will remain confidential.
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