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PHARMACIST CONVICTED OF CONSPIRACY TO DEFRAUD MEDICARE AND MEDICAID

February 16, 2011

BOSTON, Mass. - A Roxbury pharmacist was convicted today in federal court of conspiracy to defraud the United States government by submitting false claims to Medicare Part D and Medicaid, which are both federally funded programs.

ALOYSIUS C. NSONWU, 64, of Roslindale, pleaded guilty to an Information charging two counts of conspiracy to defraud the government.

At today’s plea hearing, the prosecutor told the court that had the case proceeded to trial, the evidence would have proven that NSONWU, a registered pharmacist, and owner of Egleston Square Pharmacy in Roxbury, paid customers to bring Medicare Part D insurance cards to the pharmacy so that he could submit claims under the names of the beneficiaries to the Medicare Program. NSONWU solicited and used beneficiary cards and information to submit claims for payment to Medicare Part D, which reimburses pharmacies for prescription drugs, for the prescriptions and refills of HIV/AIDS medications, without physically dispensing the medication to the individuals. Many of the individuals whose insurance cards were billed for these HIV/AIDS medications were not, in fact, HIV positive.

On numerous occasions, NSONWU and his co-conspirators, using the identity of a licensed practicing physician, forged prescriptions for HIV/AIDS medications, and submitted the claims to Medicare Part D for reimbursement. NSONWU used the physician’s name and prescribing identity without the knowledge or permission of the physician. As a result of these false billings for HIV/AIDS medications, NSONWU received more than $100,000 in reimbursements from the Medicare, Part D program.

Further, in a second conspiracy, NSONWU obtained legitimate prescriptions from certain Medicaid beneficiaries, particularly individuals who did have HIV/AIDS. When these beneficiaries brought their prescriptions into Egleston Square Pharmacy, NSONWU first confirmed that the prescriptions were approved for payment by Medicaid and then entered the prescriptions into the pharmacy computer and submitted the claims to Medicaid electronically. NSONWU paid the Medicaid beneficiaries a fee in cash without dispensing the medications. Some of these medications fraudulently billed to Medicaid cost hundreds of dollars per one-month supply. NSONWU received more than $46,000 in Medicaid reimbursements for one customer alone.
U.S. District Court Judge Joseph L. Tauro scheduled sentencing for May 10, 2011. NSONWU faces up to 10 years imprisonment, to be followed by three years of supervised release and a $250,000 fine on each count.

United States Attorney Carmen M. Ortiz and Susan J. Waddell, Special Agent in Charge of the U.S. Department of Health and Human Services,Office of Inspector General, Office of Investigations made the announcement today. The case was investigated by the Department of Health and Human Services, Office of Inspector General, Office of Investigations and the Medicaid Fraud Division of the Massachusetts Attorney General’s Office. It is being prosecuted by Assistant U.S. Attorneys Shelbey Wright and Brian Pérez-Daple of Ortiz’s Health Care Fraud Unit.

 

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