Virginia’s Medicaid Fraud Control Unit (MFCU) pulled in more than $1.1 billion in fraud recoveries between 2012 and 2014 by nurturing partnerships with federal agencies and using specialized software that analyzed case documents for keywords.
A large chuck of Virginia’s recoveries was linked to a $1.5 billion settlement between Abbott Laboratories and the federal government for off-label use of an anti-seizure medication, a portion of which was credited to the state’s MFCU, according to a report from the Office of Inspector General (OIG).
Virginia’s fraud detection unit leveraged partnerships with the Food and Drug Administration, the Internal Revenue Service and the Social Security Administration to prosecute Abbott. The FDA’s “significant forensic capabilities” offered a unique insight in to pharmaceutical investigations, and the IRS assisted in freezing funds and tracking potentially fraudulent payments.
The state MFCU also used e-discovery software that could analyze millions of pages of case documents for keywords or subject matter, and share information with federal partners more efficiently. All told, the anti-fraud efforts translated to $34 in recoveries for every dollar spent on fraud prevention and detection, according to the OIG.
The former deputy chief of the fraud section at the Department of Justice recently told FierceHealthPayer: Antifraud that the feds are trying to “leverage criminal and civil healthcare prosecutorial resources as much as possible” to crack down on fraud. Over the last several years, federal authorities have shown a willingness to collaborate with other state and federal agencies, particularly when it comes to large, national fraud takedowns.
- read the OIG report