Jersey City pharmacy to pay $825k to settle Medicaid fraud allegations

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A Jersey City pharmacy has agreed to pay $825,300 to settle a joint investigation by the State Comptroller and the Medicaid Fraud Division that revealed thousands of unsupported claims improperly paid with Medicaid funds, Comptroller Philip James Degnan announced.

Herbert's Drug & Surgical in Jersey City. Photo via Google Maps.
Herbert’s Drug & Surgical in Jersey City. Photo via Google Maps.

By John Heinis/Hudson County View

Based on a pharmaceutical inventory analysis performed by the Medicaid Fraud Division,  Herbert’s Drug & Surgical pharmacy claims for reimbursement lacked documentation from corresponding invoices for more than 8,000 claims between February1, 2009 and March 31, 2014.

Medicaid providers, including pharmacies, are required by State law to document services in order to be reimbursed by Medicaid program funds. The pharmacies’ failure to maintain records supporting these claims created the basis for MFD’s recoveries.

“Proper record keeping is vital to ensure against fraud, waste and abuse in the Medicaid program. Director Lichtblau and the Medicaid Fraud Division staff remain vigilant in rooting out non-compliance,” Degnan said in a statement.

As part of its oversight role, MFD audits and investigates health care providers, managed care organizations and Medicaid recipients to identify and recover improperly expended Medicaid funds.

Suspected Medicaid waste, fraud or abuse can be reported to the MFD by calling its toll-free hotline at 1-888-937-2835 or by submitting a complaint form at http://www.state.nj.us/comptroller/divisions/medicaid/complaint.html.