Pubdate: Fri, 26 Dec 2003
Source: St. Petersburg Times (FL)
Copyright: 2003 St. Petersburg Times
Contact:  http://www.sptimes.com/
Details: http://www.mapinc.org/media/419
Author: Alisa Ulferts

STATE TAKES AIM AT MEDICAID FRAUD

A Senate Subcommittee Will Offer Legislation This Spring To Recover An 
Estimated $1.2-Billion Lost Each Year To Fraud

TALLAHASSEE - Crooked pharmacies, doctors and Medicaid patients are soaking 
Florida taxpayers for millions of dollars in painkillers and phony cancer 
treatments, officials say.

Attorney General Charlie Crist has made Medicaid fraud a top priority, a 
grand jury has spent months investigating and now a new Senate subcommittee 
will recommend legislation this spring to recoup the estimated $1.2-billion 
lost each year.

But lawmakers say more is at stake than money: innocent lives.

"There's no question it's happening in Florida and it's costing millions of 
dollars and it's costing lives as well," said subcommittee member Sen. Mike 
Fasano, R-New Port Richey.

About 80 percent of all prescription drugs illegally sold for fraud in 
Florida were paid for by Medicaid, the federal-state health care program 
for the poor. The drugs are then resold on what investigators call the gray 
market. "Before these drugs can be sold illegally on the street, someone 
has to fill the prescription," Fasano said. So he wants to target the 
source of the drugs: doctors and pharmacists.

Here's how it works: Medicaid patients go shopping for doctors willing to 
write prescriptions for large quantities of drugs such as OxyContin, that 
have street value. Pharmacies fill the prescription, the public pays for 
it, and the Medicaid patients then sell the drugs.

OxyContin addicts are dying from overdoses from those Medicaid drugs at an 
alarming rate: three to five people a day.

"There are numerous personal tragedies," said Sen. Burt Saunders, the 
Naples Republican who chairs the Senate subcommittee. "We just need to get 
our hands around it."

Sometimes, unscrupulous doctors working with Medicaid patients write 
prescriptions for expensive cancer and HIV drugs the patients don't need. 
Crooked pharmacies, often set up for the express purpose of bilking the 
system, bill the state as much as $7,000 a month for the drugs but don't 
deliver them to the patients. Instead, the drugs are repackaged and sold 
through a web of drug wholesalers, with the prescribing doctor getting a 
cut of the resale price.

Eventually the drugs wind up again on the shelf of a pharmacy that gets 
them much cheaper than it would if bought directly from a drug manufacturer.

But these illegal dealers either don't know or don't care how vulnerable 
the medications are to breakdown.

"What's scary is that most of this stuff has to be refrigerated, and it's 
sitting in someone's trunk," said Jack Calvar, an investigator with the 
Medicaid Fraud Control Unit in Crist's office. Reputable pharmacy chains 
such as Eckerd and Walgreens keep close tabs on the source of their 
medications, he said. But smaller, independent stores, particularly those 
in poor neighborhoods whose residents lack insurance, may not be as careful.

"You don't know that this has been sitting around a crack house for three 
weeks," Calvar said.

A statewide grand jury has been investigating this year and on Thursday 
issued a series of recommendations to lawmakers. But the report also 
accused state officials of failing to control fraud and protect the public 
from potentially tainted drugs.

"While Florida has taken some positive steps recently, our efforts pale 
compared to what other states are doing and, in some cases, have been doing 
for a long time," the grand jury wrote.

"The result is the waste of hundreds of millions of dollars, exploitation 
of Medicaid recipients, and the tainting of our supply of critical 
lifesaving medication."

Diane Fernandez, a Medicaid fraud investigator in the state Attorney 
General's Office, said drug ringleaders go door to door in public housing 
projects searching for Medicaid patients willing to cooperate in exchange 
for the street drug of their choice.

"They know Medicaid prescriptions and Medicaid recipient numbers are 
currency," Fernandez said.

Crist and Miami-Dade State Attorney Katherine Fernandez-Rundle on Friday 
announced the arrests of two Miami pharmacy owners, who were charged with a 
combined 39 counts of Medicaid fraud. Juan Carlos Dominguez, owner of 
Pharmed Pharmacy in Miami, was charged with forging prescriptions for 
Medicaid patients who say they never set foot in his pharmacy or received 
the drugs. He's also charged with billing Medicaid for "pharmaceutical 
products" he never sold to customers. State officials say he defrauded 
Medicaid of $393,681.

Stanley Davenport, owner of Community Pharmacy in Miami, also is accused of 
billing Medicaid for products he never ordered for his stock nor delivered 
to patients. He's accused of defrauding the state of more than $519,983.

"These arrests should serve as a warning that this type of behavior will 
not be tolerated," Crist said.

Before July 1, anyone could sell prescription drugs by filling out a simple 
application and paying for a dealer's license.

This spring, the same grand jury that released a report last week 
criticized Florida's lax oversight of drug wholesalers and pharmacies, and 
lawmakers passed the Prescription Drug Safety Act of 2003.

It requires a detailed accounting of prescription medication, in the form 
of "pedigree papers," from manufacturer to pharmacy, guaranteeing its 
authenticity and safety. It also required prospective wholesalers to 
provide detailed information, including criminal background checks, to the 
state. Stiffer penalties for those who knowingly sold fake medication were 
also part of the new law.

But the law doesn't go fully into effect until 2006, leaving investigators 
like Calvar and Fernandez to play catch-up.

Fasano and Saunders say they want to give state investigators the tools 
they need to find the fraud. The Senate Select Subcommittee on Medicaid 
Prescription Over-prescribing will meet several times in January and 
February before delivering its findings to the Senate.

"It seems as though where government is involved people come up with ideas 
of how to defraud the government," Fasano said.

His interest in stemming prescription drug abuse goes back several years. 
He has sponsored legislation that would track all narcotic prescriptions, 
regardless of whether the state was paying for them, to identify the 
patients and doctors who abuse prescriptions. So far, it hasn't become law. 
This year, he'll add Medicaid prescription abuse and fraud to his 
legislative portfolio.

"I don't know if we'll uncover $1-billion in fraud but if we could get to 
the tip of the iceberg that's money we could use for other things."
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MAP posted-by: Larry Stevens