San Juan, Puerto Rico – The United States Attorney’s Office for the District of Puerto Rico has recovered over $4.1 million from four Puerto Rico pharmacies and their owners during the period from February 26 to May 28, 2026. The pharmacies and owners have agreed to pay $4.6 million to resolve allegation of Medicare and Medicaid fraud between January 2021 and January 2024, for billing for diverted prescriptions sold to unsuspecting patients which had been misrepresented as properly sourced, despite unverifiable origins. Officials warn that such practices threaten patient safety and the integrity of federal health programs, which require medications to come from approved distributors. Diverted drugs may be improperly stored or handled, affecting their safety and effectiveness.
Read more on www.justice.gov
Action Details
- Date:June 4, 2026
- Agency:U.S. Attorney’s Office, District of…
PAYROLL & HR CONTROLS (PREVENTING “GHOST” SCHEMES)
Payroll fraud is often the hardest to detect because it “looks” like a normal business expense.
- Segregation of Duties (SoD): The person who adds new employees to the system must not be the same person who approves the monthly pay run.
- Mandatory Vacation Policy: Require all financial and HR staff to take 5–10 consecutive days of leave annually. Fraud often surfaces when the perpetrator isn’t there to “hide” the trail.
- Ghost Employee Audit: Perform a quarterly “Headcount Reconciliation” where managers must physically verify every name on their payroll list exists.
- Self-Pay Blocking: Ensure the payroll software has a hard-coded block preventing administrators from editing their own salary or bank details.