Again this year the Washington State MFCU took a leadership role in investigating, prosecuting and negotiating the multi-state settlements. The unit also received accolades for the work that it has done on these important cases:
- National Recognition. The MFCU was recognized by the National Association of Medicaid Fraud Control Units for “its many contributions, dedication in negotiating the federal/state healthcare fraud settlement with Parke-Davis/Warner-Lambert/Pfizer” at its Annual Conference in Boston, MA. Parke-Davis was one on many multi-state cases that the Unit was involved with.
- United States vs. Serono Laboratories, Inc. MFCU was involved in the investigation and prosecution of Serono Labs which resulted in guilty pleas and a civil settlement where the defendant agreed to pay $704 M to resolve its criminal and civil case. The case involved the off-label marketing of the drug Serostin, an AIDs wasting drug. Washington State is expected to receive $2.9M. The Washington State recovery more than pays for all of the drugs purchased by the Medicaid program between 1998 – 2004.
- King Pharmaceuticals. The case involved the defendant’s misreport of its “best price” to the Medicaid rebate program thus depriving the states of rebates. It resulted in a $124 million civil settlement with all 50 states. Washington State Medicaid settlement was approximately $778,000.
In addition there were several major state cases prosecuted. Some of these are:
- State v. Sanders. This defendant pled guilty to two counts of Identity Theft in the First Degree, one count of Theft in the First Degree and six counts of Theft in the Second Degree. Sanders assumed the identity of her juvenile wards’ in-home care provider and billed DSHS for over five years using the provider's name; she was paid approximately $90,000 she was not entitled to receive. Sanders had two Washington I.D. cards issued in the provider's name, but with her photograph.
- State v. Friedman. An information alleging 16 counts of Theft in the First Degree and one count of Theft in the Second Degree was filed on November 10, 2005. Friedman billed DSHS, allegedly with the help of a DSHS caseworker, for 17 months alleging to be providing services to three different Medicaid recipients when in fact he had not provided any services. Friedman billed and was paid approximately $45,000 he was not entitled to receive.
- United States v. Star Physical Therapy. This corporation was ordered to pay $655,559 in restitution and a $50,000 fine after it pled guilty to two counts of Health Care Fraud for billing Medicare and Medicaid for private aquatic therapy sessions when in fact the sessions were group sessions that should have been billed at a much lower rate.