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A court in Seville has convicted a pharmacist for a fraud offence involving nine "fictitious dispensations" of an expensive medication she herself had been prescribed as a patient with osteoporosis and user of the Andalusian public health service (SAS). The woman kept submitting invoices and received a reimbursement from the SAS, although the dispensations were never actually made and she never provided the supporting documentation.
The defendant has now been sentenced to two months in prison and a 1,200-euro fine, which she is appealing before the High Court of Justice of Andalucía (TSJA).
After being diagnosed with osteoporosis, on 1 April 2014 the pharmacist was prescribed a drug called Prolía 60 milligrams, which was to be administered once every six months through an injection. The treatment was due to last five years.
According to a ruling issued on 20 January, in order to pay only half the price of the medication (set in 2015 at 225.59 euros), went to a doctor from the SAS, who on October 23, 2014, prescribed her Prolia, "which was dispensed by the defendant's own pharmacy the following day". The ruling then stated that the accused obtained "a second dispensation of the medication on April 13, 2015, through the same mechanism", noting that "billing to the SAS was recorded and supporting documentation was submitted for at least the first dispensation, with the treatment plan extending over a 365-day period". This means that the first dispensation was legal.
"On 19 May 2015, an error happened in the prescription of the drug by a third SAS doctor, who prescribed Prolía with a dosage of one pre-filled syringe every 24 hours and with a treatment duration of 216 days, which allowed access to this number of injectables". According to the court, using the "erroneous prescription", the defendant dispensed a Prolía injectable through her own pharmacy on 19 May 2015, "being already aware at that time of the incorrect dosage set".
"The medicine was invoiced and its supporting sheet was submitted using the W@rda prescription digitalisation software. However, the defendant, aware of the error and with an obvious profit intention, taking advantage of her dual status as a patient/user of the SAS and owner of the pharmacy, and in breach of the applicable regulations, made nine fictitious dispensations of the drug Prolía, generating the corresponding fraudulent invoicing to the SAS without the drug having been acquired or accompanied by any supporting documentation," the sentence stated.
"The pharmacist, who is familiar with the system, took advantage of it, knowing that it is practically impossible to compare dispensations with invoicing. She took a minimal risk to obtain an economic profit to the detriment of the public patrimony." According to the ruling, the defendant "was counting on the system" to "not notice the nine fraudulent dispensations", considering the mountain of documentation it has to deal with.
In 2015, the medicine had a fixed price of 225.59 euros, "of which 50% (112.79) was financed by the SAS, who paid the defendant the sum of 1,015.11 euros for the aforementioned dispensations". The SAS reimbursed her a total of 1,015.11 euros on May 2016.
The court in Seville sentenced the pharmacist to two months' imprisonment and a fine of 1,200 euros, with the mitigating factors of undue delay and repairing the damage, and acquitted her of the possible offence of false documentation which she had also been charged with.
The conviction is subject to appeal to the High Court of Justice of Andalucía (TSJA), because, although the defendant and her defence have recognised the facts as such, they disagree "on the subjective and anti-juridical significance of the facts, concluding that they do not constitute a crime", under the premise that "the dispensations were nothing more than an advance on the injectables that she would need in the future for the treatment of osteoporosis, thereby avoiding having to go to the SAS doctor for future prescription renewals".
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