Attorney General Todd Rokita on Tuesday celebrated the recovery of $100 million in Medicaid provider fraud during his tenure in office since 2021.
The fraud is largely related to over-billing by providers and drug theft. He has no authority over recipient fraud.
“Today’s announcement is important for all Hoosier taxpayers who value accountability in government … and want actors held accountable for their wrongdoing,” Rokita said. “It’s especially meaningful for our neediest citizens, our most vulnerable, who rely on Medicaid as a reliable source of the essential medical care that they need.”
Indiana’s annual Medicaid spend for state fiscal year 2024 was $19.4 billion, of which $4.1 billion was state funded.
Rokita lauded the Medicaid Fraud Control Unit that receives tips and investigates provider fraud. He said the money comes from 89 separate recoveries of various amounts, some through civil settlements and others via criminal prosecutions.
The unit since January 2021 has secured 252 indictments, 233 convictions and 292 exclusions from being allowed to continue billing Medicaid.
“It’s also a deterrent effect,” said Matthew Whitmire, director of the unit. “Providers see that they’re being held accountable for over billing, for split billing, for billing for services not rendered. It gives them pause when they see their colleagues held more responsible for this and have to pay back those those funds and perhaps go to prison and be excluded from the program.”
Here are a few examples of cases that resulted in recoveries:
- In northern Indiana, an individual was using fake credentials to provide psychiatry services to children. She was sent to prison and ordered to pay $284,000 in restitution.
- The office came to a $1.7 million settlement with a doctor who overcharged Medicaid for urine testing.
- Another case recovered over $200,000 for a home health care provider submitted claims for maximum hours authorized to provide even though employees weren’t actually working them.
- The office is now data mining billing to more proactively find fraud. One case found businesses overcharging for pulse oximeters — sometimes charging Medicaid $2,000 for a device that typically costs around $30.
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