Local Politics

State roots out $53M in Medicaid fraud

Posted January 3, 2011

Money

— North Carolina’s Medicaid fraud investigators recovered more than $53 million and investigated dozens of cases of fraud and patient abuse in 2010, Attorney General Roy Cooper said Monday.

“Medicaid cheaters rob taxpayers, hurt needy patients and push medical costs higher for all of us,” Cooper said in a statement. “We’re stopping the waste and abuse and making violators pay.”

During the federal fiscal year that ended Sept. 30, the Medicaid Investigations Unit of the state Attorney General's Office won 22 criminal convictions and negotiated 18 civil settlements worth $53.5 million. Several of the cases started with referrals by the state Department of Health and Human Services, which identified tens of millions of dollars in possible overpayments and waste.

The Medicaid fraud unit has recouped more than $400 million over the past decade and helped to convict more than 450 people on criminal charges, including patient abuse and neglect as well as financial fraud.

Medicaid is a joint federal-state program that provides health insurance for the poor.

In the largest single case in 2010, drug maker Pfizer paid $25.5 million to North Carolina to resolve charges that the company cheated the state’s Medicaid program. The state alleged that Pfizer paid illegal kickbacks and marketed drugs for unapproved uses in order to sell more of certain drugs, including Bextra, Geodon, Zyvox and Lyrica.

Investigators also recovered nearly $1.9 million from a mental health provider in Fayetteville and Dunn that fabricated and forged records to overcharge Medicaid and Tricare, a program that provides health insurance to members of the U.S. military and their families. Sandra Elliott, owner of Learning Links, pleaded guilty in January 2010 to health care fraud and aiding and abetting fraud. She was sentenced to 120 months in federal prison to be followed by three years of probation.

The Medicaid Investigations Unit will expand its focus on waste and abuse, particularly on community service providers that commit fraud. The unit is doubling in size, with 25 new attorneys and investigators.

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  • almagayle50 Jan 4, 2:15 p.m.

    And yet they're still ignoring documented cases in Chapel Hill, because this town always gets a free pass.

  • CozyCake Jan 3, 7:38 p.m.

    Hey folks-lets stay on topic. You are taking a simplistic view at best in blaming illegals for the woes of a government that you folks permitted to be in power-by your vote and inactivity. This is not a country where you can be Monday morning quarterbacks on the political front.

  • coolwill43 Jan 3, 7:31 p.m.

    PS: Any child kid born in the US from a illegal immigrant qualifies for Medicaid. Medicaid for Infants and Children (MIC) provides medical coverage for children under age 19. The income limits are determined by the family size and the age of the children for whom you are applying. Medicaid for Pregnant Women only covers services related to pregnancy. SCHIP Bill Increases Illegal Immigrants' Access to Medicaid and Undermines Welfare Reform. Some illegal’s get food stamps- not for themselves, but for their American born children. (More) If the immigrant is over 65, they can apply for SSI and Medicaid and get more than a woman on Social Security, who worked from 1944 until 2004. She is only getting $791 per month because she was born in 1924 and there's a 'catch 22' It is interesting that the federal government provides a single refugee with a monthly allowance of $1,890. Each can also obtain an additional $580 in social assistance, for a total of $2,470 a month. This compares to a

  • pbjbeach Jan 3, 7:17 p.m.

    BARRACKAWHACK:

    I hate to be the one to inform you but the republicans are the ones under th former BushAdmin that refuse to increase the federal funding to protect an help the border to enforce the borders of this country an to shut it down once an for all to help keep the illegals out of this country but no way was that ever going to happen as that the coportae instrest an the special instrest groups of the repbulican party like big business want them in this country in order to help[ the to suppresse the available wages being earned in this country by har working american indivsuals in this country that what this whole recession has been about is the rergationating of wages an benefits for the american worker an suppressing their salarys an benefiits along with it soo you can thank the bush cheney adminstration for his deals an dealibng with the former mexicoan president FOX for the illegals being in this country to start with simply because they refused to fund the border patrol

  • pbjbeach Jan 3, 7:06 p.m.

    Now they need to g oafter the fraud waste an abusive spending within the north carolina department of transportation an root out the wasteful spending by the indivsual mangers of the indivsual agencys withint the north carolina department of transportation especially when it come to the issues of contracting fruad anfruadlent claims that are being allowed to be filed by contracting agencyys that are ending up getting paid two an three time in some cases for doing the exact same work over an over an over time after time an they are still alowing to be paid for this bad work time an time again. what a waste of the taxpayers revenue dollars an if thei supposley gobvernors of ours was doing her supposley jobs dutys she would have it throughly investigated from the top to the boom of the mangament satructure an put an nend too it once ann for all for the strict betterment of the states taxpaying citizens but she will never put a stop to the waste fruad an abusevies practices within the NCDO

  • coolwill43 Jan 3, 7:01 p.m.

    How about no one that enters this country illegal should receive any benefits, and if they give birth one of the parents must be proven to be a US citizen. This alone will save the state (tax payers) plenty of cash.

  • sadie1278 Jan 3, 6:35 p.m.

    Average Guy, sorry but you are incorrect. Medicaid DOES provide for emergency medical care for illegal immigrants, to the tune of BILLIONS annually. But they are ineligible for most other public benefits at this time.

  • delilahk2000 Jan 3, 6:18 p.m.

    I MEANT BURST YOUR BUBBLE.

  • delilahk2000 Jan 3, 5:36 p.m.

    AVERAGEGUY, I HATE TO BUST YOUR BUT , THEY DO GET MEDICADE, FOOD STAMPS, ETC. I HAVE SEEN IT. SO MAYBE YOU NEED TO GET THE FACTS .....

  • Nancy Jan 3, 5:33 p.m.

    And then there is this news:

    Sec. Kathleen Sebelius Sec. Kathleen Sebelius – Fri Dec 31, 10:07 am ET

    Read Sec. Kathleen Sebelius's other articles on HuffingtonPost.com

    The good news is that Oregon and other states have responded with ambitious efforts to find these children and sign them up for health coverage. Earlier this week, our department awarded $206 million in performance bonuses to states that have significantly increased the number of children enrolled in Medicaid and streamlined their enrollment and renewal processes to make it easier for families to sign up.

    These bonuses were a key part of the historic Children's Health Insurance Program Reauthorization Act, which President Obama signed last February, making millions more children eligible for coverage and giving states new financial incentives to get and keep kids covered.

    ---------------

    Our taxes (or China's money, our debt) are being used to pay bonuses to people who are doing their job? Sheesh.

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