N.C. AG Announces Record Medicaid Fraud Wins

North Carolina’s Medicaid fraud investigators have recovered a record amount of money and criminal convictions in 2004, Attorney General Roy Cooper announced recently.

“Medicaid fraud cheats taxpayers and hurts needy patients,” said Cooper. “Our investigators are cracking down on Medicaid abusers and making them pay.” Criminal convictions and money garnered this federal fiscal year are reportedly the highest achieved in the history of the North Carolina Department of Justice.

The Medicaid fraud unit investigated and closed 68 cases of Medicaid fraud between Oct. 1, 2003 and Sept. 30, 2004. Investigations lead to 35 criminal convictions and 13 civil settlements that recovered nearly $19 million from Medicaid abusers.

The 2004 successes top last year’s record-setting fraud busts, which resulted in $14 million recovered and 31 criminal convictions.

In the first success of the new federal fiscal year that begin Oct. 1, 2004, Schering Plough has paid $15 million toward North Carolina’s Medicaid efforts to resolve allegations that it failed to accurately disclose its lowest available price on the allergy drug Claritin.

North Carolina, 49 other states and the District of Columbia had charged that the company did not pay sufficient rebates to state
Medicaid programs. Of the total settlement, about $5 million goes to the North Carolina Medicaid program and the public schools and the rest goes to support federal Medicaid efforts in the state.

Meanwhile, the Medicaid Investigations Unit will reportedly continue to aggressively investigate fraud and abuse of Medicaid benefits by nurses, doctors, hospitals, pharmacies and other health care providers, according to Cooper. The Unit also investigates patient abuse and neglect in nursing homes and other Medicaid-funded
facilities.

These figures represent a 13 percent increase in the number of criminal cases closed and a 35 percent increase in funds recovered from Medicaid fraud.