June 23, 2018
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Pharmacy denied Medicaid payments; Legislator’s business accused of fraud

The Associated Press

OAKLAND, Maine — A state legislator whose pharmacy is accused of Medicaid fraud learned Monday that the Department of Human Services is withholding all reimbursement payments for the program from his business.
The state contends that True’s Pharmacy has received about $3.6 million more in Medicaid reimbursement payments than it should have over the past five years as a result of incorrect bookkeeping and billing.
Rep. Robert Nutting, a Republican, said the allegations stem from disagreements over record keeping and rules for Medicaid billing.
Nutting vigorously denies that he committed fraud and has offered to take a lie detector test to prove his innocence.
Nutting said DHS had been withholding half the Medicaid reimbursements in an attempt to recoup some of the alleged losses but that he learned Monday night that the agency would begin withholding all reimbursements.
“They have decided to withhold all our money immediately, and that causes me to have to stop doing Medicaid billing as of Friday,” Nutting said.
Nutting said the move would hasten the demise of his business and place an increased burden on Medicaid clients who believed they had time to make arrangements with another pharmacy.
True’s had decided to withdraw from the program voluntarily on Dec. 25.
“We’re just trying to recover the state taxpayers’ money,” said DHS spokesman Newell Augur.
DHS alleges that the pharmacy has no record of providing many of the services or goods for which it sought Medicaid reimbursement. In instances where records exist, True’s allegedly overbilled Medicaid for services or goods, the department says.
Nutting’s lawyer, former U.S. Attorney Jay McCloskey, said the pharmacy’s only real error was committed when an employee threw out some records that were supposed to be kept for five years.
McCloskey said it is easy to prove through other means that the goods and services were in fact provided.
The allegations of overbilling stem from an interpretation of billing rules that other pharmacies also have made and continue to make, McCloskey said.
McCloskey also said the state is using the threat of criminal prosecution to get Nutting to stop fighting attempts by DHS to recoup money.
Nutting had filed a suit in federal court aimed at delaying DHS’ earlier decision to withhold 50 percent of Medicaid reimbursements from the pharmacy.
“The Department of the Attorney General has repeatedly communicated to counsel for True’s that there is a pending criminal investigation into True’s billing and record-keeping practices,” an affidavit filed as part of the suit states.
Marci Alexander, director of the health care crime unit at the state Attorney General’s Office, said she could neither confirm nor deny whether a criminal investigation was under way.

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