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Medicaid fraud in South Carolina largely tied to health care providers | Your Health

When the Justice Department announced in July that the federal authorities would press expenses towards greater than 400 health care providers, together with 115 docs, in the most important health care fraud bust in historical past, U.S. Attorney General Jeff Sessions referred to as it “a historic day.”

“Too many trusted medical professionals like doctors, nurses, and pharmacists have chosen to violate their oaths and put greed ahead of their patients,” Sessions said in the announcement. “Amazingly, some have made their practices into multimillion dollar criminal enterprises.”

No one from South Carolina was named in the takedown, which alleged that these providers submitted $1.three billion in false claims to the federal Medicare, Medicaid and Tricare packages, however that doesn’t imply health care fraud doesn’t exist right here. New numbers offered by the S.C. Attorney General’s Office present state investigators have recognized tens of millions in Medicaid fraud in the Palmetto State in current years. And overwhelmingly, health care providers are those at fault.


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Between 2012 and 2016 in South Carolina, Attorney General Alan Wilson’s workplace recovered greater than $90 million in fraud tied to providers and, throughout the identical 5 years, recovered about $2.eight million in fraud tied to Medicaid recipients. 

One cause the restoration quantities between supplier and recipient fraud are vastly totally different is as a result of it is harder for Medicaid sufferers to defraud the system. Patients might lie about their revenue on their software and the state Medicaid company might not catch the false info through the revenue verification course of, however these instances are comparatively uncommon and the fraud is usually detected inside a comparatively brief time-frame. 

On the opposite hand, one supplier who defrauds the system might deal with a whole lot of sufferers over a number of years, stated Nancy Cote, who heads the Medicaid Provider Fraud part in the S.C. Attorney General’s Office.

“Provider fraud cases cut across a wide range of behavior over a longer period of time, which explains why the amount of money involved is greater,” she stated. 

In one current case, Cote stated, South Carolina recovered $5 million from the pharmaceutical firm Wyeth. Investigators alleged the corporate knowingly “concealed, avoided or decreased an obligation” to pay drug rebates for sure drugs to the state Medicaid program. That case concerned different states and lots of sufferers. 

If you observed a health care supplier is committing Medicaid fraud, you possibly can place an nameless tip to the Attorney General Alan Wilson’s workplace by calling 1-888-NO-CHEAT. If you observed a Medicaid beneficiary is defrauding the system, name the S.C. Department of Health and Human Services at 1-888-364-3224.

Reach Lauren Sausser at 843-937-5598. 


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