July 25, 2010

Attorney general prosecutes Medicaid fraud

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About $16 million of the $26 million returned Medicaid funds were a direct result of investigations and prosecution by the Attorney General’s Office, said spokeswoman Raquel Guillory. Roughly half of that money was paid back in civil settlements, while the other half was court-ordered restitution.

“What we deal with varies from big settlements with pharmaceutical companies to individual providers,” Guillory said.

Some fraud cases caught by the Attorney General’s office during FY 2010 include:

* A $321,173 settlement from global pharmaceutical company Aventis, which misreported its lowest prices for three steroid nasal sprays.

* A $862,267 settlement from four large drug companies, which misclassified their drugs to get more money from Medicaid.

* Former mental health counselor Joanne Radulski of Fallston billed the Medicaid program for psychotherapy services she was not licensed to perform. She was sentenced to two years in prison, which were suspended, and four years of supervised probation. As a condition of probation, she must serve six months home detention and pay restitution of $17,000.

* Medical supplier Neil Wayne Goldschmitt of Burtonsville billed the Medicaid and Medicare programs and private insurance companies for wheelchairs that he never provided. He was sentenced to two years in prison, which were suspended, and five years of supervised probation. He must serve six months of home detention, pay restitution of $36,370, and perform 200 hours of community service. He also was barred from being a Medicaid or Medicare provider for five years.