The Department of Justice’s 2026 National Health Care Fraud Takedown should get the attention of every pharmacy owner and operator.

According to the DOJ, the coordinated enforcement action involved 455 defendants and more than $6.5 billion in allegedly false claims. The cases spanned 56 federal districts and 45 states and territories. The government also reported more than $182 million in asset seizures.

For pharmacies, however, the more important point is how the government built the cases.

The case summaries show prosecutors and regulators comparing claims data against drug purchases, inventory, dispensing records, prescriber patterns, patient information, marketing arrangements and controlled-substance records. When those records do not line up, what begins as an invoice request, payment review or PBM audit can become a fraud investigation.

The Government Is Following the Drug

Several cases begin with a straightforward question: did the pharmacy lawfully acquire and dispense the drug for which it billed?

In Hawaii, the government alleged that a pharmacy billed Medicare for drugs it did not dispense and lacked sufficient inventory to support claims for certain high-cost products. In Michigan, prosecutors charged participants in an alleged “pharmacy shortage” scheme involving approximately $1.9 million in claims unsupported by adequate inventory. In New York, authorities alleged that pharmacies received more than $12 million for prescriptions that were not dispensed or...

Read Full Story: https://news.google.com/rss/articles/CBMiwgFBVV95cUxNcE1ndXBiMjctM1haTlVCSjZG...