Medicaid fraud busts in several states point out concerns for consumers

Medicaid fraudState officials are fighting a number of incidents of Medicaid fraud across the United States, including drug marketing, charging for services not performed and fraudulent billing.

Consumers can become Medicaid fraud victims due to the actions of doctors, pharmacists and medical equipment companies, according to The Center for Medicare and Medicaid Services, Medicaid is funded by both local and federal governments to help provide health care to people who can't afford to pay.

Medicaid fraud can, but not always, affect some patients' ability to receive future care. "If their Medicaid number gets used with a certain prescription, it would show that they've received it in the past and they wouldn't be able to fill it in the future," Peter Ashkenaz, spokesman for the center, told Consumer Ally.

He warned that a consumer's Medicaid identification number is like a credit card number and should be guarded accordingly.

In Michigan, the state attorney general filed a suit against pharmacist Edward Nantais, who runs Mattawan Pharmacy. The complaint alleges Nantais and his pharmacy billed Michigan Medicaid for pricey prescriptions never given to Medicaid patients. Michigan's Health Care Fraud Division conducted an investigation that found $35,000 in fraudulent Medicaid billing from 2006-2009. CVS Caremark also conducted an audit on Nantais and found private insurers along with the Medicaid program were fraudulently billed $1,750,000.

The website for Mattawan Pharmacy says it is temporarily unavailable and no one could be reached during the pharmacy's listed business hours.

James McCurtis, spokesman for the Michigan Department of Community Health, told Consumer Ally, "When you have fraudulent activity, those who really pay the price are those who ultimately need the care."

The Missouri AG is bringing three criminal felony charges against a Missouri audiologist, Dana Opfer, alleging Medicaid fraud. The state says Opfer submitted false Medicaid reimbursement claims for services she did not perform. According to subpoenaed records, Opfer fraudulently billed $12,000 for services and hearing devices.

Medicaid programs will receive $19.2 million in a settlement case involving 49 states and the District of Columbia. Arkansas, Florida, South Carolina, Texas and Vermont led an investigation against Alpharma, Inc. The company is now paying up for making fraudulent claims about their drug, Kadian, a morphine-based pain killer also known as MS Contin, prescribed for cancer and severe injury and a frequent target of pharmacy thefts. Earlier this month, the U.S. Food and Drug Administration jailed a Baltimore pharmacist for misbranding and stockpiling Kadian, among other drugs.

Idaho, which received more than $51,000 in the settlement, alleged Alpharma engaged in practices such as paying for training programs and publishing false information about the drug's safety in order to entice health care providers to issue Kadian prescriptions.

If you suspect Medicaid fraud, Ashkenaz suggests contacting your state Medicaid representative or calling the Office of the Inspector General's Fraud Hotline.
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