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AG Kilmartin's Medicaid Fraud and Control Unit Recovers More than $8.1 Million for the State's Medicaid Budget

AG Kilmartin's Medicaid Fraud and Control Unit Recovers More than $8.1 Million for the State's Medicaid Budget

In 2013, Rhode Island Attorney General Peter F. Kilmartin's Medicaid Fraud and Control Unit (MFCU) recovered more than $8.1 million for the state's Medicaid budget.

"Medicaid is one of Rhode Island's most expensive programs and cannot afford to be plagued with fraud, waste and abuse," said Attorney General Kilmartin. "From big pharma looking to pocket tens of millions of dollars in profits through the off-label marketing of drugs to individual caregivers who defraud the system a few hundred dollars at a time, each must be held accountable."

Last year, the MCFU entered into 16 settlement agreements with major pharmaceutical companies who engaged in off-label billing and/or overbilled the state for drugs totaling $6.8 million in monies returned to the Medicaid budget. The year's single largest settlement was announced in November; Rhode Island received $5.6 million as its share of a multistate and federal settlement with Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, Inc., to resolve civil and criminal allegations of unlawful marketing practices to promote the sales of their atypical antipsychotic drugs, Risperdal and Invega.

The MFCU also recovered $1,276,530 in civil penalties from physician practices for overbilling and coding errors, including a $244,923 settlement with a former Rhode Island physician, Dr. Hafeez Kahn. In addition, the Unit secured court-ordered restitution of $81,365 from individuals convicted of Medicaid Fraud or patient abuse.

The Medicaid Fraud Control and Patient Abuse Unit (MFCU) enforces the laws pertaining to fraud in the state Medicaid program and prosecutes cases of abuse, neglect or mistreatment of patients in all state healthcare facilities. The Unit prosecutes criminal activity, pursues civil remedies where appropriate and participates with federal and state authorities in a variety of inter-agency investigations and administrative proceedings. In addition, the MFCU works closely with federal and state authorities to investigate pharmaceutical companies who overbill and defraud the state's Medicaid program.

In 2012, Attorney General Kilmartin created an online, anonymous Medicaid fraud complaint form, allowing individuals to file complaints directly to the Office of Attorney General for investigation and prosecution when appropriate. To report Medicaid Fraud, patient abuse or neglect, please call (401) 222-2566 or (401) 274-4400 ext. 2269 or visit www.riag.ri.gov.

Related links

Department or agency: Department of the Attorney General

Online: http://www.riag.ri.gov/

Release date: 01-27-2014

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