State v. Ms. B (DMC No. 11862) – Felony Fraudulent Schemes, (2 Counts) Acquisition of a Dangerous Drug by Fraud & Identity Theft – Reduced to Solicitation Class 6 Open/Misdemeanor with 6 Months Probation and Zero Days in Jail –Maricopa County Superior Court (Case No. CR2013-002734).

Ms. B worked in a Doctor’s office as a medical assistant. She routinely would call in scripts on behalf of clients to various pharmacies. She was pressured into calling in some scripts for a coworker for various opiates. In addition, she called in a prescription for herself for an appetite suppressant. This was all done without the knowledge of the Doctor and in violation of ARS 13-3407, Acquisition of a Dangerous Drug by Fraud. It also qualified as a Fraud Scheme per ARS 13-2310 and Identity Theft per ARS 13-2008.

The Doctor found out about the scheme when she was called by Walgreens and the pharmacist asked if she normally prescribed this many pills (60) in a refill of Tramadol. The Doctor had no idea what the pharmacy was talking about and Phoenix Police Department was contacted. Eventually the Arizona Attorney General’s Healthcare Fraud and Abuse sections became involved, and an Investigator contacted Ms. B. Ms. B was interviewed with her boss/doctor present and she was never read her Miranda rights. She admitted to what had happened. She was then charged with Fraud Schemes, 2 Counts of Acquisition of a Dangerous Drug by Fraud, and ID Theft.

We became involved in the case and we informed the Prosecutor that it was the other coworker who was coercing Ms. B. into calling in prescriptions. The other coworker never cooperated with investigators, and we discovered that she had been convicted of Identity Theft in the state of New Jersey. Ultimately, we presented detailed Mitigation to the Prosecutor and they agreed to offer a plea to a single count of Solicitation, which is a Class 6 Open/Misdemeanor. She received 6 months of Probation and Zero Days in Jail. After 6 months of Probation, she had the case designated a Misdemeanor.

Unfortunately, her conviction qualified under 42 USC 1320(A)(7) and 42 CFR 1001.101(C). This means that Ms. B. was excluded from participation in any capacity (including employment) regarding Medicare, Medicaid and all Federal Healthcare Programs as defined under section 1128 B(F) of the Social Security Act for a minimum statutory period of five years. This includes any state healthcare program which is funded by Federal money. The exclusion had a significant effect on her ability to work in the healthcare field. However, because her conviction was designated a Misdemeanor, she had the ability to challenge the exclusion which was issued by the Department of Health and Human Services, Office of the Inspector General.