North Carolina to Expand Medicaid Fraud Investigations Unit

The North Carolina Attorney General’s Office recently announced that it will be doubling the size of the Medicaid Fraud Investigations Unit in the coming months. The state will be adding 25 new investigators and attorneys to a team that already has a reputation for zealously going after people suspected of health care fraud.

In 2010, the Medicaid Fraud Investigations Unit was responsible for investigating dozens of health care fraud cases. According to local news sources, the unit recovered more than $53 million in health care fraud cases in 2010 alone. They hope to top that number this year.

In the past decade, North Carolina’s health care fraud unit has been responsible for sending numerous people to jail. Investigators and prosecutors have also gotten more than $400 million since 2000 for the state in these cases.

As an example, the unit investigated the drug company Pfizer in 2010. Prosecutors argued that the company was paying kickbacks to doctors who prescribed their drugs and marketing medications for unapproved uses. The company agreed to pay the state $25.5 million to resolve the lawsuit.

But health care fraud charges do not only impact powerful drug companies that have the money to fight the charges. Individuals and small business owners are also impacted by these accusations. The owner of a North Carolina company called Learning Links was sentenced to spend ten years in federal prison because of health care fraud accusations.

The Medicaid regulations surrounding payment of doctors, hospitals, and other health care providers are complex enough. When you add in the challenges of determining a person’s eligibility for Medicaid coverage, it is no wonder that many people find themselves facing these federal criminal charges every year. With the Attorney General’s announcement that his office will be increasing the focus on prosecuting health care fraud cases, we will likely see even more people facing accusations associated with Medicaid payments.

Source: WRAL.com, “State roots out $53M in Medicaid fraud,” Matthew Burns, 3 Jan 2011

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