A 29-year-old Arlington resident has pleaded guilty to a multi-million dollar healthcare fraud.
Federal prosecutors charged Onkur Lal with bilking Medicaid, Medicare and the TRICARE military health care system out of $3.5 million by submitting fraudulent bills for non-existent prescriptions while working at a trio of local pharmacies.
Prosecutors say Lal conspired with the owner of the pharmacies in carrying out the fraud from 2014 to 2019. After the guilty plea, Lal now faces up to five years in federal prison.
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An Arlington man pleaded guilty yesterday to his role in a conspiracy to commit health care fraud that resulted in losses of over $3.5 million.
According to court documents, Onkur Lal, 29, worked in various roles at MedEx Pharmacy, MedEx Health Pharmacy, and Royal Care Pharmacy, which were all owned and operated by the same individual. From around 2014 to around 2019, Lal conspired with the owner and others in a number of different fraudulent schemes to defraud health care benefit programs, including TRICARE, Medicare, Virginia Medicaid, and Maryland Medicaid. Lal took part in a number of fraudulent schemes, including generating false prescriptions, billing health insurance companies for prescriptions that were never filled, and billing patients’ health care benefit programs for numerous high cost medications that he and his co-conspirators knew were not prescribed and/or never received.
Lal and his conspirators also submitted false invoices under the names of other pharmacies, in an attempt to circumvent audits. Further, Lal and another co-conspirator fraudulently posed as pharmacists by elevating their title and credentials within the pharmacy’s prescription software system. Lal and his co-conspirator then used these elevated titles to verify prescriptions, which they then submitted to health care benefit programs and pharmaceutical suppliers for payment. The various schemes resulted in health care benefit programs losing more than $3.5 million.
Lal is scheduled to be sentenced on Feb. 21, 2021, and faces a maximum penalty of five years in prison. Actual sentences for federal crimes are typically less than the maximum penalties. A federal district court judge will determine any sentence after taking into account the U.S. Sentencing Guidelines and other statutory factors.
G. Zachary Terwilliger, U.S. Attorney for the Eastern District of Virginia; Maureen R. Dixon, Special Agent in Charge of the Office of Inspector General for the U.S. Department of Health and Human Services (HHS); James A. Dawson, Special Agent in Charge of the FBI Washington Field Office Criminal Division; and Dermot F. O’Reilly, Deputy Inspector General for Investigations with the Defense Criminal Investigative Services, made the announcement after Senior U.S. District Judge Claude M. Hilton accepted the plea.
Assistant U.S. Attorneys Monika Moore, Carina A. Cuellar, and Jamar K. Walker are prosecuting the case.
Flickr photo by Joe Gratz