$100 cash kickback for each false HMR


tribunal hearing legal case

A pharmacist has had her registration suspended for 18 months after she used another pharmacist’s identity to submit payment claims for 129 HMRs which were not performed at patients’ homes

An amended application had been brought against the pharmacist by the Health Care Complaints Commission, alleging unsatisfactory professional conduct and professional misconduct.

The pharmacist was employed at a pharmacy in Sydney’s west when according to the HCCC’s complaint, between May 2015 and September 2016 she made 126 false and/or misleading claims to Medicare via the online 6CPA portal about HMRs.

For these claims the pharmacist did not receive a GP referral, did not attend the homes of any patients, and did not have the requisite accreditation to perform HMRs.

She had completed Stage One of the Medication Management Review Program in 2015, and commenced but never completed Stage Two.

During this time period the HCCC alleged that she also inappropriately used the identity of another person, identified by the Civil and Administrative Tribunal NSW only as Pharmacist A, to submit payment claims for 129 purported HMRs.

This was done without Pharmacist A’s knowledge or consent.

The HCCC also complained that the pharmacist had received an inappropriate financial advantage from the pharmacy, being paid $100 in cash for each HMR she claimed had been undertaken.

On another three occasions, in April and May 2016, there was a GP referral but instead of visiting the patients, the pharmacist carried out a review at the pharmacy.

On these three occasions, she compiled an HMR report by populating a pre-prepared template for HMRs based on over-the-counter discussions with the three patients and then submitted the HMR report to the GP in the name of Pharmacist A.

The HCCC also complained that the pharmacist had acted in a false and misleading manner when in September 2016, she told her employer she had suitable accreditation for carrying out HMRs when she knew she did not; and when she told the Pharmacy Council in October 2016 that she had indeed visited the homes of patients to carry out HMRs, when she had not.

It said she also acted in a false and misleading manner when she told the Council she had not received any financial advantage from the pharmacy for the HMRs and only received an unrelated end of year bonus.

The pharmacist admitted all this conduct except that she continued to assert she had visited the homes of three patients.

Identical spelling errors and records of two patients’ eating and sleeping patterns were recorded in the paperwork for two of these patients, where only the gender had been changed for one patient. One of these two HMRs reported the patient had consumed two or three beers a day at lunch for 62 years – but the patient was born in 1972.

The Tribunal said it was not persuaded that the pharmacist had visited either of these two patients at their homes.

Her employers had been “consistently and persistently” urging the pharmacy’s staff to increase revenue, complaining that sales targets were not being met, the pharmacist said. She approached the couple with the idea of performing HMRs as a way of generating income for the business, but did not tell her employers she had not completed the relevant qualification.

She said she selected potential patients identified by the pharmacy’s software and carried out reviews at the pharmacy, aside from three patients who she had visited at home.

When interviewed by the HCCC’s investigators she conceded that the reviews had constituted MedsChecks only.

The Tribunal noted that the pharmacist “conceded that the majority of the HMR reports had not been as a result of a GP referral”.

“She said that some of the patients knew that she was performing a report and signed a consent form. She further conceded that although her reports were not fulsome, they did contain details of the patient’s medication so to that extent they represented a ‘MedsCheck’.

“When asked whether she had ever visited any of the homes of these patients she said ‘only the ones that have known me for years’. The respondent then said that there were only three such persons.

“She also said that it was possible that she would not have told some patients that she was completing an HMR claim for them.”

The pharmacist’s registration was cancelled, and she is not permitted to apply for review of this cancellation for 18 months.

She was also ordered to pay the HCCC’s costs.

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5 Comments

  1. Jarrod McMaugh
    04/08/2020

    “She further conceded that although her reports were not fulsome, they
    did contain details of the patient’s medication so to that extent they
    represented a ‘MedsCheck’.”

    Nope – that’s still not a medscheck just because a list has been made of a person’s medicines.

    • Karalyn Huxhagen
      05/08/2020

      agreed. We need to be very careful how we present Medschecks . They are not medication reconcilation but they may contain a reconciliation. There was so much fraudulent activity in this case that the penalty is well deserved. Am heartily sick of the fraudulent behaviour I see in HMR services while those of us that follow the rules are fighting hard for realistic payment dollars. Would be interesting to see what other behaviours the empolyer was up to!

      • Paul Sapardanis
        05/08/2020

        Wouldn’t the employer know that the pharmacist wasn’t HMR accredited? She seems to have been the fall guy

        • Karalyn Huxhagen
          05/08/2020

          The person committing the fraud has used another pharmacists credentials to do the claims. Depends whether the phcy claimed or the employee claimed in her own right. Depends how much trust the employer put in the employee or was she pressured to meet kpi’s and she cut corners to achieve her employers targets?this employee may have falsely claimed to be accredited and the employer never did all of the background checks?

          • actnowpharmacists
            06/08/2020

            The employee pharmacist couldn’t have done it without participation/knowledge of the owner of the pharmacy. The title says it all. She was given 100$ “cash kickback” for each HMR done. Needless to say another fine example of an owner conveniently turning a blind eye towards how HMRs were done, when they were done and by whom they were done as long as they got their cut and got to squeeze more out of their employees.

            Employee pharmacists are being pushed to increase revenue in “creative ways” but the pharmacist’s conduct in this case was beyond redemption . HMRs without accreditation, without GP referrals, not visiting homes and doing them without consent. She deserve to have her registration cancelled.

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