Medicaid fraud investigators recovered a record amount of money and criminal convictions in 2003, the state Attorney General’s Office says.
The state investigated and closed 72 cases of fraud in the federal fiscal year, Oct. 1, 2002 to Sept. 30, 2003. Investigations led to 31 criminal convictions and 22 civil settlements that recovered more than $14 million from Medicaid abusers.
“Cheating Medicaid robs taxpayers and keeps patients from getting the care they need,” Attorney General Roy Cooper said in a press release. “Our investigators have increased their efforts and it’s paid off.”
For example, Glaxo Smith Kline Beecham this week paid $3.1 million toward North Carolina’s Medicaid efforts to resolve allegations that it failed to accurately disclose its lowest available prices on the prescription drugs nasal spray Flonase and antidepressant Paxil.
North Carolina and other states had charged that the company did not pay sufficient rebates to state Medicaid programs. Of the total settlement, about $1.3 million goes to the North Carolina Medicaid program and public schools and the rest goes to support federal Medicaid efforts in the state.
Medicaid is a federal-state program that provides health insurance for the poor. Additional settlement money from Bayer in a related case is expected next year.
Meanwhile, the Medicaid Investigations Unit will continue to aggressively investigate fraud and abuse of Medicaid benefits by nurses, doctors, hospitals, pharmacies and other health care providers, Cooper said. The unit also investigates patient abuse and neglect in nursing homes and other Medicaid-funded facilities.
These figures represent a 24 percent increase in the number of criminal cases closed and a 30 percent increase in funds recovered from Medicaid fraud. Funds go to support North Carolina’s Medicaid program and public schools.
Richard Wagner is the editor of Carolina Journal.