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State recovered $335M from Medicaid fraud

ALBANY -- The state attorney general's office recovered more than $335 million last year from Medicaid fraud and abuse, the agency reported yesterday.

The total, including $146 million from a multistate settlement with pharmaceutical giant GlaxoSmithKline, is the second highest annual recovery by the office's Medicaid Fraud Control Unit.

One of the unit's most notable victories last year was shutting down a scheme to distribute black market prescription HIV drugs through Long Island-based MOMS Pharmacy, which billed Medicaid more than $155 million. The case is ongoing.

Budget documents show New York spending nearly $54 billion for Medicaid in the 2012-2013 fiscal year. Attorney General Eric Schneiderman's office said there's no clear guidance on how much Medicaid billing is typically fraudulent.

Typical frauds include medical providers billing for services they never gave, double billing Medicaid and private insurers, phantom patient visits and falsifying symptoms or diagnoses to bill for unnecessary services and tests, according to the National Association of Medicaid Fraud Control Units. Schneiderman credited added prosecutors, investigators and auditors for boosting the fraud unit.-- AP

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