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…
MANAGEMENT & CULTURE (THE “TONE AT THE TOP”)
Fraud thrives in “sloppy” environments where leadership ignores the rules.
- The Fraud Triangle: For fraud to occur, three elements must be present: Pressure (the need for money), Rationalization (thinking “I deserve this”), and Opportunity (weak controls). You can only control the Opportunity.
- Whistleblower Hotline: Provide an anonymous way for staff to report “odd behavior.” Most internal frauds are caught via tips, not audits.
- Background Checks: Conduct credit and criminal record checks for all employees in financial or data-sensitive roles.
- Annual Ethics Training: Make sure every staff member knows that the company has a Zero Tolerance policy toward “borrowing” from petty cash or fudging overtime.