Maine investigations of Medicaid fraud resulted in nearly $7.5 million in recoveries, primarily from drug companies, in fiscal year 2013, according to new federal data.
Nearly all of that money, which includes funds due to the federal government, was owed by drug makers to settle civil charges, including improper marketing of prescription medications.
One of the highest-profile cases was a $2 billion settlement by pharmaceutical company Johnson & Johnson, based in New Jersey, that was described as one of the largest health care fraud settlements in U.S. history. The company was accused of paying kickbacks to doctors and pharmacies to promote the antipsychotic drugs Risperdal and Invega, and the heart disease drug Natrecor. Maine received nearly $2.9 million of that settlement.
The new data, from an annual Office of Inspector General report on state Medicaid fraud control units, summarizes results of investigations and civil and criminal prosecutions. Maine investigated 38 cases of fraud, abuse and neglect in the Medicaid program, known as MaineCare. The investigations resulted in 10 criminal prosecutions and six civil settlements and judgments, according to the report.
The $7.5 million in recoveries for Maine may not reflect actual collections and may involve cases involving other federal and state agencies, the report noted.
Nationally, Medicaid fraud control units reported 1,341 criminal convictions, with recoveries of nearly $1 billion, along with 879 civil settlements and judgments in fiscal year 2013. Civil recoveries topped $1.5 billion, mostly involving multistate settlements.