PANORAMA

Berlin  -  The US health authorities are currently faced with the problem of so-called "phantom pharmacies". A ghost-like emptiness is characteristic: There are no medicines on the shelves, employees are nowhere to be found, customers are non-existent. And yet, these fake pharmacies produce bills for medication and defraud the state health insurance system Medicare of millions of US dollars per year.

The fraudsters always act in a similar way: First they trick patients – mostly seniors or immigrants – into handing over their billing information. Then they rent a shop and write out bills. By the time they have collected the fake reimbursements, the phantom pharmacies have long since closed and their operators have disappeared without a trace. Some "pharmacies" only exist for a few days.

The fraudsters make use of a law according to which the insurance companies have to settle bills submitted online by pharmacies within two weeks. The deadline for postal claims is 30 days.

In a letter to the US Secretary of Health and Human Services Kathleen Sebelius, Senator Charles Grassley from Iowa draws attention to eight phantom pharmacies from Miami and Los Angeles that were uncovered in 2008. A fraudster from Miami raked in 245,000 dollars in less than three months before disappearing to Europe.

Another phantom pharmacy from Miami only existed for two days, but in this time it billed 106,000 dollars for HIV medicines. It was only after a neighbour confirmed that the conspicuously expensive pharmacy did not even exist that the insurer stopped the payments.

Two phantom pharmacies from Los Angeles lasted significantly longer: They each billed the same insurance company high amounts for one and a half years. One fraudster claimed 1.3 million dollars – twice as much as a neighbouring branch of the pharmacy chain Rite Aid. The second phantom pharmacy billed 5 million dollars; the deception came to light in an audit. The fraudsters went into administration and thereby denied the insurance company compensation and access to the shares.

The deceived insurance company first addressed the responsible authorities of Medicare as well as the US Ministry of Health more than a year ago. A reaction has so far failed to materialise; as a result of the senator's letter, the Ministry of Health now wants to examine the accusations.

Janina Rauers, Fri, May 21, 2010 04:23pm CET