A.G. Schneiderman Announces Over $335 Million In Medicaid Fraud Recoveries For Taxpayers In 2012- Capital Region

ALBANY – Attorney General Eric T. Schneiderman today announced that his office recovered over $335 million in 2012 that had been improperly claimed through fraud or abuse in the Medicaid system. 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 taxpayers and their government,” Attorney General Schneiderman said. “That initiative has paid off with record recoveries for taxpayers this year, including in the Capital Region. 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.”

Attorney General Schneiderman’s Medicaid Fraud Control Unit brought a number of significant actions to protect patient safety in the Capital Region, including:

• Busted the Rensselaer-based owner of a Manhattan nurses agencyfor bilking Medicaid of $300,000 by scheduling nurses to work prohibited shifts of 24 to 48 hours, and then falsely billing the state to conceal their regulatory violations.

• Indicting a practicing dentist in Rome and Saratoga Springs for failing to include earlier Medicaid fraud charges in his Medicaid Provider Enrollment application and failing to report to US HHS/OIG that he was working as a dentist at two clinics, Lake Avenue Dental and Rome Family Dental, which accept Medicaid in violation of his exclusion.

• Obtaining a guilty plea from a Licensed Practical Nurse at Champlain Valley Physicians Hospital(CVHP) for forgery and Criminal Possession of a Controlled Substance after she created 16 forged prescriptions for Hydrocodone and Xanax for personal use. We also charged another LPN at the same facility for stealing Oxycodone pills from a resident for her own use.

• Indicting a worker at Whittier Rehab & Skilled Nursing Center, for committing medication errors resulting in a resident death by overdose of morphine. The worker was also involved in narcotics thefts.

• Arresting a registered nurse who was working at Glendale Home in Schenectady County after she administered 10 mg of Roxanol (morphine) to the wrong resident. Following the incident the resident fell into a “stuporous coma.” Also, on eight different occasions, she failed to administer medications to two residents. Charges are pending in Glenville Town Court.

• Charging an LPN at Van Rensselaer Manor Nursing Home in Troy, with Falsifying Business Records in the First Degree, and Willful Violation of Health Laws. The LPN wrongfully administered 12 units of insulin to a resident, resulting in the resident being sent to the emergency room, and then intentionally falsified medical records in order to conceal the error. This defendant pled guilty in January.

MFCU also shut down schemes to illegally obtain prescription drugs through Medicaid and distribute them on the street for profit, and obtained prison sentences for the heads of two separate drug rings. 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 prescription 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 Kathleen Boland supervises the MFCU Albany 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.