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Record Medicaid fraud wins for NC in 2005, announces AG Cooper

Release date: 10/27/2005

North Carolina recovers record $30 million from Medicaid fraud cases in 2005

Raleigh: North Carolina’s Medicaid fraud investigators recovered a record amount of money in 2005, Attorney General Roy Cooper announced today.

“We’ll keep up our crackdown on Medicaid fraud so that patients get help and providers offer quality care at a fair cost to the taxpayers,” Cooper said.

The North Carolina’s Medicaid fraud unit, housed in Cooper’s N.C. Department of Justice, recovered more money this federal fiscal year than in any previous year in the department’s history. The Medicaid fraud unit investigated and closed 70 cases of fraud and patient abuse between October 1, 2004 and September 30, 2005. Investigations lead to 26 criminal convictions and nine civil settlements that recovered nearly $30 million from Medicaid abusers.

More than $4 million in Medicaid penalties won by Cooper’s office went to local public schools, with the bulk of the remainder going to state and federal Medicaid efforts in North Carolina. Medicaid is a joint federal-state program that provides health insurance for the poor.

These latest successes build upon last year's record-setting fraud busts, which resulted in $19 million recovered and 35 criminal convictions. The 2005 figures represent a more than 50 percent increase in funds recovered from Medicaid fraud.

In one of the final cases of the federal fiscal year that ended September 1, 2005, Gambro Healthcare Inc. recently paid $37.5 million to North Carolina and 40 other states to resolve claims that it improperly billed Medicaid for home dialysis supplies and equipment. North Carolina and the other states had charged that the company overcharged state Medicaid programs for dialysis services and unnecessary tests, and that the company paid kickbacks to physicians in exchange for patient referrals to a Gambro clinic. Of the multistate settlement, $1.5 million will go toward Medicaid efforts and public schools in North Carolina.

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.

“When Medicaid cheaters abuse the system, patients and taxpayers suffer,” said Cooper. “Thanks to our investigators’ efforts to root out fraud, we’re making Medicaid abusers pay.”