Western New York Pharmacy Pays State $2 Million In Medicaid Probe
Parkview Health Services, Inc. of Tonawanda, has agreed to pay a total of $2,050,000 to resolve allegations that it improperly over-supplied Medicaid recipients with more pharmaceuticals than they actually needed and that it also wrongly billed Medicaid for refilled prescriptions that lacked the supporting documentation required by law.
"My office is working aggressively to combat fraud and abuse throughout the Medicaid system. In this case, the office is recovering more than $2 million that resulted from improper billings."
The civil settlement by the Attorney General's Medicaid Fraud Control Unit resolves allegations that from January 2000 through March 2004, Parkview routinely delivered 30 days worth of medications every 28 days - and billed Medicaid for each delivery - to more than 5,000 Medicaid recipients residing in hundreds of adult and group homes located in Chautauqua, Erie, Genesee, Monroe and Niagara counties.
The MFCU contended that this delivery system resulted in the waste of substantial quantities of drugs paid for by Medicaid. Further, MFCU's investigation revealed that Parkview accepted returns from some adult and group homes of the accumulated excess drugs - without credit to Medicaid.
The settlement also resolves allegations of billing irregularities uncovered by a MFCU audit, including instances where, contrary to Medicaid regulations, Parkview billed for drugs in excess of the number of refills called for by prescription, when there was no prescription, no physician signature on the prescription, or no written prescription to support refills of telephone orders.
In the settlement agreement, Parkview agreed to repay Medicaid in full for the overpayments that MFCU alleged Parkview had received, which totaled more than $1.6 million. It further agreed to pay more than $400,000 in interest.
Spitzer thanked the New York State Department of Health (DOH) and the State Education Department's Office of Professional Discipline for their assistance during the course of the investigations.
The audit-investigation resulting in the settlement was conducted by Special Assistant Attorney General Gary A. Baldauf, Deputy Director-in-Charge of the MFCU's Buffalo Regional Office. Assisting on the case were: Supervising Special Auditor Investigator Jerome Higgins, under the supervision of Assistant Chief Auditor Paul Bermel; Senior Special Investigator Valerie Robinson, under the supervision of Supervising Special Investigator DeWayne Baker; Randall Kent, Confidential Systems Analyst; and Paul Mahoney, Chief of the MFCU Civil Enforcement Unit.