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AG Cooper announces record Medicaid fraud wins for NC

Release date: 10/13/2004

North Carolina recovers record $19 million from Medicaid fraud cases in 2004

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

“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 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 October 1, 2003 and September 30, 2004. Investigations lead to 35 criminal convictions and 13 civil settlements that recovered nearly $19 million from Medicaid abusers.

“We will continue our efforts to root out fraud so that patients get the help they need and providers offer quality care at fair prices,” Cooper said.

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 October 1, 2004, Schering Plough this week 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. Medicaid is a joint federalstate program that provides health insurance for the poor.

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 thirteen percent increase in the number of criminal cases closed and a 35 percent increase in funds recovered from Medicaid fraud. Funds go to support North Carolina’s Medicaid Program and public schools.