NEWARK, N.J. – United States Attorney Robert Frazer announces criminal charges against 6 defendants in connection with an alleged scheme to defraud Medicare and Medicaid involving a doctor and other medical professionals issuing medically unnecessary prescriptions to a pharmacist in exchange for cash kickbacks.
“The District of New Jersey remains committed to aggressively rooting out fraud, waste, and abuse committed by doctors, pharmacists, and medical professionals who betray their patients in pursuit of greed. Our Office will continue to ensure that those individuals who bilk our insurance systems to line their pockets with taxpayer dollars face swift justice.”
– U.S. Attorney Robert Frazer
“Each of the defendants had a unique role in this alleged scheme, but the common thread is a complete disrespect for the Medicare and Medicaid programs that so many Americans rely on,” said…
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.