State recovers $7M from Medicaid fraud

2009-10-03T23:00:00Z State recovers $7M from Medicaid fraudBy JOAN BARRON Casper Star-Tribune The Billings Gazette
October 03, 2009 11:00 pm  • 

CHEYENNE - Wyoming's share of settlements in Medicaid fraud cases totaled $7 million between 1993 and 2009.

In some of these cases, Wyoming collected more money than much larger states.

"That's why it's beneficial for us to participate" in global cases, said Christine Cox, executive director of the Medicaid fraud control unit in the Wyoming attorney general's office.

Cox said the amount states receive from a settlement depends on the amount of use of a drug or the impact on a state.

It's a good thing for Wyoming that the money isn't distributed on a per capita basis when a company does a lot of business in Wyoming and not in Montana, for example. Montana's Medicaid recoveries between 1993 and 2009 totaled $7.8 million.

It was in 1993 that Congress mandated states set up Medicaid fraud control units.

In the 2007 Pediatrix Medical Group settlement, Wyoming recovered $1.4 million of the total $21 million.

California and a dozen or so other states received zero dollars. Arkansas received $14, according to an August 2009 report from the National Association of Medicaid Fraud Control Units.

The Pediatrix settlement for improper Medicaid billing was the largest single payment the state received since 1993. The total includes the federal government's share of roughly 60 percent and the state's share of 40 percent.

The second largest was from the $646 million Eli Lilly settlement for improper marketing of the anti-psychotic drug Zyprexa. Wyoming collected $874,021. The state's share, $342,403, will go into the general fund earmarked for use next year to match federal Medicaid dollars, Cox said.

Two more settlements are pending - from Metronic pharmaceutical company and Mylan Pharmaceutical Co. Metronic was accused of giving kickbacks to physicians for persuading hospitals to buy the company's equipment. Wyoming's total share, state and federal, is about $33,000.

The state's total share in the Mylan case, which involved improper billing for Medicaid prescriptions, is about $40,000.

Given national estimates on the scope of Medicaid fraud, the amount of Wyoming overpayments could be as much as $30 million a year, Cox said earlier.

One of her goals is to get a state false claims act that would allow the state to collect treble damages in these fraud cases. Colorado has such a law.

"To me that says the state is serious about Medicaid fraud," Cox said.

Contact Joan Barron at joan.barron@trib.com or 307-632-1244.

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