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State investigators recovered more than $52 million in Medicaid fraud in 2008, N.C. Attorney Gen. Roy Cooper announced today.
The attorney general's Medicaid Investigations Unit won 17 criminal convictions and 15 civil settlements in Medicaid abuse in the fiscal year that ended Sept. 30, 2008. They follow record-setting Medicaid fraud arrests made over the last seven years that have resulted in more than $300 million being recovered by the state, Cooper's office said.
"Ripping off Medicaid keeps needy patients from getting care and drives up health care costs for all of us," Cooper said in a statement. "We'll keep working to protect patients from abuse and stop taxpayers' money from being wasted."
Cooper's unit, part of the N.C. justice department, aggressively investigates fraud and abuse of Medicaid benefits by nurses, doctors, hospitals, pharmacies and other health care providers. It also probes patient abuse and neglect in nursing homes and other Medicaid-funded facilities.
One of the first cases resolved in the current fiscal year was against Cephalon, Inc., the pharmaceutical company. North Carolina won $15.5 million against Cephalon, part of a $375 million national settlement that resolves allegations that the company marketed three drugs for uses no approved by the federal Food and Drug Administration.
Under the settlement, $1.9 million will go to the state's Medicaid program and $3.5 million in fines and penalties will go to public schools.
Those drugs are:
Provigil, a drug the FDA approved to treat narcolepsy and sleep disorders but the company marketed as a non-stimulant drug to treat sleepiness or lack of energy and fatigue.
Gabitril, a drug approved to partially treat seizures, but marketed by Cephalon to remedy anxiety, insomnia and pain.
Actiq, an FDA-approved drug to treat cancer patients where morphine-based painkillers are no longer effective. Cephalon marketed the drug to treat migraines, sickle-cell pain and other injuries.
