- Office of Attorney General Maura Healey
Media Contact for Marshfield Pharmacy and Owner Charged With False Billing to MassHealth and Insurers
Thomas Dalton, Deputy Press Secretary
PLYMOUTH — A Marshfield pharmacy and its owner have been charged in connection with a fraudulent scheme to bill the state’s Medicaid program (MassHealth) and other private and government-funded insurance plans for prescriptions for which they never possessed the inventory to fill.
St. George Pharmacy in Marshfield and its owner, Atef Ayoub, 45, of Marshfield, were indicted Tuesday by a Plymouth County Grand Jury on one count each of Medicaid False Claims, Medicaid Reverse False Claims, False Health Care Claims to Private Insurer, Reverse False Health Care Claims to Private Insurer, Excess Charges to MassHealth members, and two counts of Larceny over $1,200. The defendants are set to be arraigned in Plymouth County Superior Court at a future date.
The AG’s Office alleges that Ayoub billed Medicaid and other insurance plans for prescriptions for a heartburn medication, Zegerid, for which the pharmacy did not have the necessary inventory to fill. In particular, the AG’s Office found that the defendants allegedly billed for nearly 37,000 units of Zegerid even though records indicate that the pharmacy only had approximately 12,000 units on hand. This resulted in the pharmacy receiving approximately $442,000 in inappropriate reimbursement from various insurance plans.
In addition to the lack of inventory, the investigation by the AG’s Office found that the defendants regularly accepted cash payments from Medicaid recipients for prescriptions for controlled substances, in many cases charging cash in an amount over and above what MassHealth would have reimbursed the pharmacy. The AG’s Office contends that the pharmacy knowingly allowed patients to pay cash for controlled substances, including narcotics and benzodiazepines, when it knew that they were MassHealth members and that the controlled substances were covered by insurance.
These charges are allegations and the defendants are presumed innocent until proven guilty.
This matter is being handled by Assistant Attorney General Gregoire Ucuz, Senior Trial Counsel Elisha Willis, Investigations Supervisor Christopher Cecchini, and Investigator Caitlin Albert, all of Attorney General Maura Healey’s Medicaid Fraud Division. MassHealth, Tufts Health Plan, The Drug Enforcement Administration’s Boston Tactical Diversion Squad, and the Marshfield Police Department all assisted with the investigation.
The AG’s Medicaid Fraud Division receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the Commonwealth of Massachusetts.