West Virginia Record

Wednesday, April 1, 2020

Medicaid unit adds punch to AG’s fraud fight

Their View

By Patrick Morrisey | Mar 3, 2020


CHARLESTON – West Virginia gained a huge advantage in its fight against waste, fraud and abuse with the transfer of the state’s Medicaid Fraud Control Unit.

The unit’s move brings West Virginia in line with 46 other states, but perhaps more importantly, it creates tremendous synergies for the state. It combines our state’s need to combat Medicaid fraud with our office’s already vigorous fight against Social Security disability fraud and consumer fraud.

Those efforts recover millions upon millions each year to the benefit of taxpayers and consumers across West Virginia. We expect nothing less from the Medicaid Fraud Control Unit.

We must save every dollar possible if we hope to ensure continued medical care for hard-working, yet low-income families who legitimately need the assistance. Every dollar counts.

We cannot allow criminals to steal from the system. These bad actors – whether it be a major corporation or a local provider – jeopardize a crucial safety net.

That’s why our office is bolstering the unit with additional investigators and attorneys. These individuals will strengthen the Medicaid Fraud Control Unit’s ability to identify bad actors and pursue aggressive enforcement actions.

A settlement with the maker of Suboxone – Reckitt Benckiser Group – exemplifies how the unit’s achievements protect the integrity of Medicaid.

The broad, multistate settlement requires the company to provide West Virginia with more than $11.98 million. The state keeps more than $2.93 million, while the balance reimburses federal Medicaid dollars spent on the fraudulent care of West Virginia patients.

For instance, the Medicaid Fraud Control Unit alleged that Reckitt misspent Medicaid dollars by marketing its drug as something that reduces opioid abuse and misuse, despite having no scientific evidence to support its claims. The unit also charged that Reckitt paid kickbacks to prescribers, took steps to improperly control pricing by fraudulently delaying generic competitors and promoted the sale or use of Suboxone film based on deceptive claims that the film carried less risk for abuse than other buprenorphine products.

All of this bilked Medicaid of millions, and the result illustrates the vigor with which our unit will do everything possible to hold bad actors accountable.

Our unit cannot fight alone. We want everyone’s help.

One great way you can join this good fight is by reporting suspected wrongdoing to the fraud unit’s tipline, 888-372-8398. Specialists with the unit review the information to see which items are actionable.

By working together, we can better thwart those who game the system for criminal gain.

Fighting such fraud is a passion for us, whether it is by generating more than $20.4 million in disability fraud savings since late 2015 or by recovering hundreds of millions in consumer fraud since 2013.

Just as our disability unit works to protect Social Security for decades to come, our proven track record will now be fully brought to bear in hopes of protecting Medicaid.

These combined efforts will help thwart a culture of fraud, waste and abuse, and through that success, together we will help West Virginia reach her full potential.

Morrisey, a Republican, is the West Virginia's Attorney General.

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