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Crime

Jim Maxwell: Florida Needs to Step Up Efforts to Fight Prescription Drug Fraud

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There‭’‬s an old saying that an ounce of prevention is worth a pound of cure.‭ ‬That‭’‬s just as true in law enforcement as it is in medicine‭ ‬– and it‭’‬s badly needed here in Florida.‭

Every year,‭ ‬prescription drug fraud committed by independent pharmacists costs‭ ‬patients,‭ ‬taxpayers and businesses billions of dollars in the form of higher prescription drug costs.‭ ‬This problem is‭ ‬serious,‭ ‬and lawmakers need to take real action to prevent and crack down on it.

Recently,‭ ‬a federal jury convicted Peter Bolos,‭ ‬the owner‭ ‬​​of Synergy Pharmacy in Palm Harbor,‭ ‬Florida of committing‭ ‬$174‭ ‬million in prescription drug fraud.‭ ‬His specific crimes include conspiracy to commit health care fraud,‭ ‬22‭ ‬counts of mail fraud‭ ‬and felony misbranding of medication.‭

Bolos and his‭ ‬employees conspired to rig‭ ‬prescription purchases,‭ ‬deceived and stole insurance information from Florida patients‭ ‬and misled doctors into writing expensive and unneeded prescriptions.‭ ‬Millions of dollars were stolen from hardworking Floridians and funneled into these‭ ‬criminals‭’‬ pockets.‭ ‬This is a particularly despicable offense given that so many Floridians struggle to afford prescription drugs.‭ ‬And worse,‭ ‬several of the‭ ‬groups‭ ‬that‭ ‬Bolos‭ ‬defrauded work‭ ‬to help‭ ‬seniors and veteran families through public health‭ ‬programs like Medicare and Tricare.

Organizations‭ ‬called‭ ‬Pharmacy Benefit Managers‭ (‬PBMs‭) ‬can help stop this type of fraud‭ ‬– which is‭ ‬700 percent‭ ‬more likely to occur at independent pharmacies‭ ‬than at‭ ‬chain or retail pharmacies.‭ ‬PBMs‭ ‬work to provide affordable,‭ ‬accessible prescription drugs to patients by negotiating with big drug companies on behalf of plan sponsors like employers,‭ ‬unions,‭ ‬and public health programs.‭

PBMs also serve as the first line of defense against prescription drug fraud by using state-of-the-art techniques when working with pharmacies to detect and report‭ ‬suspicious behavior.‭ ‬However,‭ ‬restrictions‭ ‬and regulations‭ ‬that state lawmakers have placed on PBMs make it harder to stop this criminal activity and keep costs down for patients.‭

Given‭ ‬the multi-million dollar price tag of Bolos‭’‬ crimes,‭ ‬and the significant taxpayer cost of investigating and trying his case,‭ ‬encouraging PBMs and empowering them in their pharmacy oversight role should be a no-brainer.‭

Yet,‭ ‬instead of supporting PBMs‭’‬ efforts to prevent this criminal activity,‭ ‬some Florida legislators have tried to attack them with burdensome regulations.‭ ‬Last session,‭ ‬multiple bills were introduced that would have undermined‭ ‬innovative cost-saving‭ ‬methods utilized by‭ ‬PBMs to lower drug costs for employers,‭ ‬consumers,‭ ‬and the health system.‭ ‬They also would have‭ ‬weakened PBMs ability to detect and stop pharmacy fraud.‭

Going into‭ ‬2022,‭ ‬there is already pre-filed legislation like HB‭ ‬357‭ ‬and SB‭ ‬742‭ ‬that may again restrict PBMs in ways that will harm Floridians.‭ ‬Why are our legislators seeking to weaken‭ ‬PBMs‭ ‬that‭ ‬help to‭ ‬keep costs down for patients when our health‭ ‬care system is already working overtime heading into the third year of the COVID-19‭ ‬pandemic‭?

Prescription drug fraud is a crime,‭ ‬and our legislators need to prioritize cracking down on these bad actors so that hard-earned taxpayer dollars aren‭’‬t further wasted.‭ ‬Bolos‭’‬ case is not unique,‭ ‬and it will happen again if we don‭’‬t take action.‭ ‬To help bring down the cost of prescription drugs,‭ ‬we need our lawmakers to‭ ‬stop targeting PBMs and let these organizations make prescription drugs more affordable‭ ‬– and stop costly criminal fraud.‭

‭Jim Maxwell is the vice-chairman of Floridians for Government Accountability

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Ed Dean: Publisher

 

Ed Dean is a leading radio and news media personality including hosting the #1 statewide radio talk show in Florida. Contact Ed.Dean@FloridaDaily.com

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