The settlement of a Minneapolis-based federal medical fraud lawsuit will bring about $175,000 of the $161 million settlement into Utah coffers.
Criminal complaints filed in federal court in Minneapolis against Caremark Inc., a subsidiary of Illinois-based Caremark International, claimed the company defrauded federal health-care programs by paying kickbacks to doctors who would refer patients to Caremark, according to Utah Public Safety spokesman Sgt. Verdi White II.Caremark operates home infusion, oncology, hemophilia and human growth hormone businesses.
In Utah, state investigators found evidence that Caremark was charging insurance companies and federal health-care programs for services patients did not know about, said state Medicaid fraud investigator Sgt. Dan Taylor.
For example, pharmacies typically do not charge a separate mixing fee for taking prescription drugs from bulk containers and putting the medicines in individual patient containers. But Caremark did, with an investigation showing about $2,000 in prescription mixing fees to fill just a handful of prescriptions, Taylor said.
Utah Attorney General Jan Graham said this is one of the largest settlements ever obtained in a health-care fraud case, both nationally and in Utah. "Health-care fraud, specifically Medicaid fraud, robs from us all and from the poor," Graham said. "Fraud distorts the medical funding, boosting health-care premiums and increasing the cost of taxpayer-supported government health-care plans."
White said the General Accounting Office estimates that fraud accounts for 10 percent of all health-care dollars spent in the United States. That translates to as much as $58 million lost each year in Utah to unscrupulous and fraudulent practices.
Taylor said he believes the case was originally filed after a patient in Minneapolis received a copy of a bill and questioned the charges. "Part of the problem is that patients often never see the bill (for medical services). They're sent directly to insurance companies and Medicare," he said.
"Any time there is a case like this involving a national company, the Medicaid office in Washington will send out a fraud alert," Taylor said. "That's what brought us into the investigation."
More and more insurance providers are sending copies of bills to their patients with the hope of tripping up fraudulent practices.