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Medicaid Fraud and Patient Abuse Unit

The Medicaid Fraud Control and Patient Abuse Unit enforces the laws pertaining to fraud in the state Medicaid program and prosecutes cases of abuse, neglect or mistreatment of patients in all state healthcare facilities. The Unit prosecutes criminal activity, pursues civil remedies where appropriate and participates with federal and state authorities in a variety of inter-agency investigations and administrative proceedings. Unit prosecutors, auditors, investigators and health care professionals employ a multi-disciplinary approach to combat health care fraud and patient abuse.

In 2012, the Unit returned $9.9 million to the state’s Medicaid program in settlement agreements with pharmaceutical companies.

In 2012, the Unit focused on fraud in the home health care industry, utilizing new investigative measures to bring individuals who fraudulently bill the state’s Medicaid program for services not rendered. The Unit also created an online, anonymous Medicaid fraud complaint form, allowing individuals to file complaints directly to the Office of Attorney General for investigation and prosecution when appropriate.

In addition to investigation and prosecution, staff conducted 44 in-service trainings at nursing facilities on how to identify and report abuse, neglect and mistreatment, as well as drug diversion and Medicaid overbilling. These trainings enable the Unit to develop a positive working relationship with nursing facilities and to convey the message that it is critical to report incidents of Medicaid fraud and patient abuse for the financial health of the system and the safety of patients.

The Unit works closely with federal and state authorities to investigate pharmaceutical companies who overbill and defraud the state’s Medicaid program. In 2012, the Unit returned $9.9 million to the state’s Medicaid program in settlement agreements with pharmaceutical companies, including $4.6 million to Rhode Island as part of the single largest healthcare fraud settlement in U.S. history with GlaxoSmithKline to resolve allegations that the company engaged in various illegal schemes related to the marketing and pricing of drugs it manufactures.

In addition, Attorney General Kilmartin announced several multi-million dollar settlements with pharmaceutical companies for similar bad practices, including $1.87 million settlement with Maxim Healthcare and a $2.67 million settlement with Abbott Laboratories to reimburse the state’s Medicaid program for the company’s illegal off-label marketing of its drug Depakote.

To report Medicaid Fraud, Patient Abuse or Neglect, or Drug Diversion, please call:
(401) 222-2566 or (401) 274-4400 extension 2269