A.G. Schneiderman Announces Over $335 Million In Medicaid Fraud Recoveries For Taxpayers In 2012 - Central New York

SYRACUSE – Attorney General Eric T. Schneiderman today announced that in 2012 his office recovered over $335 million that was improperly claimed through Medicaid fraud or abuse. This was the second highest annual recovery total ever by the Attorney General’s Medicaid Fraud Control Unit (MFCU), the highest recovery in seven years.

“Part of my first major initiativewhen I took office was to bolster the Medicaid Fraud Control Unit with additional prosecutors, investigators, and auditors, in order to even more aggressively root out fraud and return money illegally stolen from New York taxpayers and their government,” Attorney General Schneiderman said. “That initiative has paid off with record recoveries for taxpayers this year, including residents of Central New York. My office’s Medicaid Fraud team will keep working hard to root out fraud wherever it exists, and protect the integrity of the Medicaid program for those who truly need it.”

MFCU was active in the Central New York area in 2012, with some of the region’s top cases including:

• A $3.1 million state and federal settlement with Cayuga Medical Center for billing Medicaid and federal health care programs for patients referred by physicians engaged in a financial relationship with the hospital;
• A guilty plea from unlicensed dentistVictor Nino, who filed for $35,000 in Medicaid claims for dental work he illegally performed at his wife’s dental clinic;
• A $465,000 settlement with Faxton– St. Luke’s Dental Health Care Center resolving claims against both clinics for overbilling Medicaid;
• A $101,000 repayment from United Health Services Senior Living at Ideal after the provider charged Medicaid for home health services not administered and filed claims on patients already covered by Medicare.

MFCU also shut down schemes to illegally obtain prescription drugs through Medicaid and distribute them on the street for profit. The head of one prescription drug ring in the Bronx and another on Staten Island received prison sentences. In addition, MFCU targeted providers that billed for unnecessary services or unnecessary visits to perform services that could have been rendered in a single visit; providers that referred patients to unlicensed facilities in exchange for kickbacks; unlicensed healthcare workers; and black market drug sellers that diverted wholesome medications of unknown origin, re-packaging and re-selling them to pharmacies.

And in 2012, MFCU continued to vigilantly pursue major pharmaceutical manufacturers that engaged in unethical marketing practices. Abbott Laboratories, Boehringer-Ingelheim, Dava Pharmaceuticals, Inc., GlaxoSmithKline, K-V Pharmaceutical Company, McKesson Corporation, and Merck Sharp & Dohme Corp, among others, paid over $250 million to settle cases where they marketed their drugs to physicians for treating conditions that the Food and Drug Administration had not approved or for marketing and illegal pricing practices. Some of those companies took criminal pleas in federal court for this conduct.

“The Medicaid Fraud Control Unit does an outstanding job, not only protecting taxpayers, but protecting patients from fraudulent practices that endangered their safety,” Attorney General Schneiderman said. “I know this unit will continue to be vigilant in the coming year and send the message that fraud and abuse that endangers patients and rips off taxpayers will not be tolerated in our state.”

Special Assistant Attorney General Ralph D. Tortora III supervises the MFCU Syracuse office.

The Medicaid Fraud Control Unit operates under the supervision of Special Deputy Attorney General Monica Hickey-Martin within the Criminal Justice Division led by Executive Deputy Attorney General Kelly Donovan.