Fraudulent pharmacists in Ontario have been pocketing millions of dollars meant for the poor over the past few years. Recent reports show that Ontario?s Drug Benefit program have been overbilled by dishonest pharmacists for hundreds of thousands of dollars up to a few million dollars at a time.
How Do They Do It?
A man who identified himself as ?The Cleaner? shared that he helps with the scam by fixing the papers and cleaning up the books of any pharmacy that availed of his services. He?s the person who makes the fraudulent pharmacy look as clean as any other pharmacy.
?The Cleaner? further shared that pharmacies flagged for overbilling by the Ontario Drug Benefit Program (ODB) usually call him to help them create a paper trail to hide their fraud and get them off the hook. The pharmacists are aware that they are committing fraud and that they could go to jail but that seems to push them, even more, to hire ?The Cleaner? to clean up their act and committing more crime in the process.
?The Cleaner? divulged that his long career in the health care field allowed him to have more insight about the system and said that he found ways to game it. He creates fake transfers from other pharmacies to fix discrepancies in inventory when Ministry of Health auditors look for medications that were billed by the pharmacy despite never having them in stock. To date, ?The Cleaner? helped disguise fraud in more than 100 pharmacies on Ontario in the last 5 years without breaking a sweat.
Pharmacists fool auditors with ?The Cleaner?s? coaching. He tells the pharmacists to tell the auditors that they simply forgot to enter certain data and to act like they knew about the medications but simply didn?t enter their data into the system. There are also instances when auditors inform the pharmacy that they are going to conduct an inspection ahead of time so ?The Cleaner? simply comes over and fixes what needs fixing in as little as just 3 hours.
The Big Impact
Ontario?s most vulnerable benefit from the medications provided by the ODB. The ODB provides medications for those on social assistance, the elderly, and children by shouldering most if not all of the medication cost for qualified patients. This program costs Ontario about $5.4 billion a year.
The province is billed by pharmacists every 2 weeks for the medications they dispensed to ODB patients and they are then paid afterward. Fraudulent pharmacists commit fraud by overbilling, listing drugs they never dispensed, and adding those to the bill they send ODB. Because of this, funds that are meant to go to the sick and needy are funneled into dishonest pharmacists? pockets.
To date, very few pharmacists are getting caught and those that were caught usually manage to avoid jail. This is a problem that is costing Ontario a lot of money as there are instances when a caught pharmacist has several pharmacies all overbilling the province but can?t be charged due to lack of evidence.
Fraud happens in any industry. Pharmacy fraud has many aspects and uncovering one still leaves a significant number behind. All that can be done is to be more vigilant for fraud detection and to have safety measures in place for fraud prevention. Our private investigation services can help with these! Contact us today!
