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Medicaid Fraud Investigators Recover More Than $14 Million

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RALEIGH, N.C. — North Carolina recovered a record dollar amount in Medicaid fraud in 2003, with 31 criminal convictions and 22 civil settlements, Attorney General Roy Cooper has announced.

Medicaid fraud investigators recovered more than $14 million during the year.

"Cheating Medicaid robs taxpayers and keeps patients from getting the care they need," Cooper said. "Our investigators have increased their efforts, and it has paid off."

Cooper's office said the settlements included $3.1 million from GlaxoSmithKline, paid this week to resolve allegations that it failed to disclose its lowest available prices on the prescription drugs Flonase and Paxil.

GlaxoSmithKline agreed earlier this year to a nationwide settlement totaling almost $88 million involving the two drugs.

The settlements and money recovered are divided in North Carolina between the Medicaid program and public schools.

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 72 cases of Medicaid fraud between October 1, 2002 and Sept. 30, 2003.

"We will continue this work next year to make sure that patients are receiving the help they need and that providers are giving fair prices and quality care," Cooper said.

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.

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