What Are Some Major Medicaid Fraud Investigations?


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Major Medicaid fraud investigations resulted in the February 2014 arrests of more than 20 people for Washington, D.C. Medicaid program fraud, and in November 2015, Millennium Health and the federal government reached a $256 million settlement, according to the FBI and the Florida Office of the Attorney General. In December 2015, Novartis Pharmaceuticals Corp. agreed to pay about $390 million to the federal government and more than 40 states for kickback schemes, states the Missouri Attorney General's office.

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As of 2015, the Washington D.C. case involves allegations of more than $75 million in Medicaid fraud, explains the FBI. Authorities executed 55 federal seizure warrants for bank account funds and motor vehicles in the case, which represents the largest effort against health care fraud in the city's history.

Formerly known as Millennium Laboratories, Millennium Health reached a settlement to pay $256 million to 49 states and Washington, D.C., for wrongful Medicaid billing and unlawful business practices, explains the Florida Office of the Attorney General. Based in San Diego, Millennium Health allegedly made illegal gifts to doctors in exchange for patient referrals to its laboratories. The laboratory company also fraudulently billed Medicaid for unnecessary and expensive genetic, urine and drug testing from January 2012 through May 2015.

Novartis, based in East Hanover, New Jersey, allegedly gave kickbacks to Accredo Health Group Inc., BioScrip Inc. and other specialty pharmacies to promote its prescription drug Exjade to Medicaid patients, according to the Missouri Attorney General. Accredo Health Group agreed to pay $60 million and BioScrip agreed to pay $15 million for allegedly receiving the kickbacks. Exjade treats blood transfusion-related chronic iron overload.

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