On Wednesday, New York Attorney General Eric T. Schneiderman announced that his office recovered over $335 million for the state in 2012 that had been improperly claimed through fraud or abuse in the Medicaid system.
According to a press release, this amount is the second highest annual recovery total ever by the attorney general's Medicaid Fraud Control Unit (MFCU), and the highest recovery in seven years.
[See also: Medicaid fraud unit recovers more than $283M in 2009]
"Part of my first major initiative when I took office was to bolster the Medicaid Fraud Control Unit with additional prosecutors, investigators, and auditors, in order to even more aggressively root out fraud and return money illegally stolen from New York taxpayers and their government," Schneiderman said in the press release. "That initiative has paid off with record recoveries for taxpayers this year .... My office's Medicaid Fraud team will keep working hard to root out fraud wherever it exists, and protect the integrity of the Medicaid program for those who truly need it."
Some of the major statewide and regional cases included the following:
▪ A $146 million agreement with GlaxoSmithKline as part of a $3 billion multi-state settlement to resolve claims that the pharmaceutical company engaged in a number of illegal schemes related to the marketing and pricing of drugs it manufactures, including Paxil, Wellbutrin and Advair.
▪ Shutting down a scheme to distribute black market prescription HIV drugs through Suffolk County-based MOMS Pharmacy and bill the Medicaid Program for over $155 million.
▪ Guilty pleas from four pharmacists and a pharmacy owner who billed the state's Medicaid program $9.9 million by submitting bills for drugs that they never dispensed to their patients.
▪ A $1.6 million recovery of excess Medicaid payments on claims for dental services provided by Kaleida Health through the Buffalo Women's & Children's Hospital Dental Clinic.
▪ A $3.1 million settlement with Cayuga Medical Center for billing Medicaid and federal programs for patients referred by physicians engaged in a financial relationship with the hospital.
In addition, the MCFU shut down schemes to illegally obtain prescription drugs through Medicaid and distribute them on the street for profit, the press release noted. The head of one prescription drug ring in the Bronx and another on Staten Island received prison sentences.
MFCU also targeted providers that billed for unnecessary services or unnecessary visits to perform services that could have been rendered in a single visit; providers that referred patients to unlicensed facilities in exchange for kickbacks; unlicensed healthcare workers; and black market drug sellers that diverted prescription medications of unknown origin, re-packaging and re-selling them to pharmacies.
[See also: Fraud charges filed against 91 individuals for $295M in false Medicare billing]
[See also: Fraud costs healthcare industry up to $600M a year]