[Updated June 2019] A well known pharmacist in Janesville, Wisconsin was arrested and charged with 46 counts of Medicaid and Medicare fraud. Federal agents with the Department of Health and Human Services charged pharmacist Mark Johnson with bilking state and federal taxpayers of $1 million. Charges include Medicaid and Medicare fraud, making false statements and identity theft.
According to court records, Johnson is the owner of Kealey Pharmacy and Home Care. He was released after processing and will be arraigned within a week.
The indictment claims that Johnson defrauded Medicare and Medicaid between January 2008 and March of 2014. He was caught during an audit by the Wisconsin Department of Health Services. As part of his alleged scheme to defraud the government, prosecutors say he:
- Submitted claims for medication that was never provided to beneficiaries.
- Created false prescription orders and submitted them for reimbursement, causing the payment of approximately $1 million by Medicare and Medicaid to him.
- Lied to auditors of the Wisconsin Department of Health Services.
- misused the federal Drug Enforcement Administration numbers and national provider identifiers assigned to local physicians in order to create fictitious physician prescription orders to support the submission of false claims to Medicare and Medicaid.
During the audit, regulators questioned Johnson about prescriptions that had been billed to the state Medicaid program and dispensed to a patient named “R.S.” According to the indictment, that patient had died. Prosecutors claim that Johnson lied when claiming “R.S.” had received the prescriptions. They also claim he provided forged signatures.
If convicted of all charges, Johnson faces 390 years in prison on the Medicare fraud charges alone. The false statement charges carry up to 5 years each. identity theft charges carry minimum two year sentences. Overall he could face 400 years in prison although typical sentences are much lower. Johnson is 55 years old.
Update: In March of 2017, Johnson agreed to plead guilty to one count of healthcare fraud. Because he took early responsibility for his actions, prosecutors agreed to cut him a break. In return, Johnson agreed to accept a restitution order and not seek a sentence of less than 12 months.
The sentencing was strange because by all accounts, Johnson was well respected in the community. He was active in church and often drove prescriptions to people’s home who were too sick to drive. According to his lawyer, a nasty divorce left him broke and owing his ex-wife hundreds of thousands of dollars.
In August of 2017, the court sentenced Johnson to 24 months of prison but said it could be served in a pre-release center meaning he could work but spend his non work time in jail. The judge indicated that Johnson needed to be held accountable for his crimes but wasn’t a danger to the community. He was also ordered to pay restitution.
In October of 2017, the Wisconsin Pharmacy Examining Board accepted the surrender of Johnson’s license in lieu of further proceedings. Neither taxpayers nor his family will likely receive full payment of the money he owes. As is often the case in healthcare fraud cases, the los of one’s professional license makes restitution particularly difficult.
Johnson was almost 60 at the time of his release. How he will generate funds is difficult. He owes approximately $1 million.
Medicaid and Medicare are funded by taxpayers. When someone defrauds either program, all taxpayers suffer. Beyond the loss of tax dollars, patients suffer too. There simply aren’t enough healthcare dollars available to provide services to everyone that needs them. In many areas of the country that means waiting lists. There is no reason that truly needed patients should go without care while some bad apples line their pockets.
We hope whistleblowers come forward early in the fraud so that these restitution amounts don’t become impossible to collect.
Medicare Fraud and the False Claim Act
More than 3/4ths of healthcare fraud cases in the United States are brought to light by whistleblowers. Although the charges in this case were brought after Johnson allegedly lied to auditors, even the auditors rely on whistleblower tips.
In most instances the whistleblower is an insider – a current or former employee who has first hand knowledge of the fraud. Under the federal False Claims Act, these insiders can earn a whistleblower award of up to 30% of what the government collects from the wrongdoer. Because damages can be tripled, the awards too can be quite large.
There are two ways of reporting fraud. Calling Medicare’s fraud hotline 1-800-MEDICARE allows you to report anonymously but you won’t receive a large cash reward. (In fact if you report anonymously, chances are good that your report goes to the bottom of the pile and doesn’t even get properly investigated,)
The best way to stop Medicare fraud and collect a reward means filing a False Claims Act case. That involves a sealed filing in federal court. Doing so puts your claim at the top of the investigations list and makes you eligible to receive up between 15% and 30% of what the government collects. Million dollar awards are not uncommon.
Most tips come through the federal hotline. Unfortunately, many hotline callers simply don’t know about the False Claims Act (also called a qui tam lawsuit). Others think that filing a qui tam complaint is difficult or expensive.
The lawyers at MahanyLaw can take all the cost and hassle out of the qui tam process. We handle the investigation, file the complaint, pay all costs and even prosecute the case on behalf of the government. You only pay us if we win and recover money for you.
The False Claims Act also has anti-retaliation provisions that protect whistleblowers still employed by the wrongdoer. Filing a complaint under the False Claims Act can better protect you from retaliation.
Need more information? Our consultations are free, without obligation and confidential. All communications with us are protected by the attorney – client privilege. We have helped our whistleblower clients recover over $100,000,000.00
Want us to evaluate your case (no fee, no obligation)? Contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). Simply interested in more information? Visit our Medicare fraud whistleblower page.
MahanyLaw – America’s Medicare Fraud Whistleblower Lawyers