DOJ Prosecutors and DHS Recover Nearly $1 Million for Wisconsin Medicaid After Blood Clotting Medicine Overpayment to Providers
MADISON, Wis. – Attorney General Josh Kaul, and the Wisconsin Department of Health Services (DHS), today announced a recovery of $856,609.39 to the Wisconsin Medicaid program after three providers failed to comply with basic program requirements regarding the prescription and dispensing of blood clotting medicine.
“As the recovery of these funds shows, the Wisconsin Department of Justice’s Medicaid Fraud Control and Elder Abuse Unit protects taxpayers and the Medicaid program,” said Attorney General Kaul. “Thank you to the members of our team at DOJ whose work contributed to this successful outcome.”
“Medicaid is a vital program that many Wisconsinites rely on for affordable, quality health care” said Secretary-designee Andrea Palm. “At DHS, we are committed to ensuring Medicaid dollars are utilized effectively and appropriately.”
Wisconsin Medicaid requires that blood clotting factor, a costly, specialty pharmaceutical product that requires close monitoring from a healthcare professional, only be dispensed pursuant to a physician’s valid prescription based upon current need and where the patient or their guardian signs for the delivery of this perishable product to prevent spoliation.
The DHS Office of Inspector General (OIG) audited several Wisconsin Medicaid providers and determined that three specialty pharmacies failed to comply with basic Medicaid program requirements regarding the prescription and dispensing of blood clotting factor concentrates.
Prosecutors in DOJ’s Medicaid Fraud Control and Elder Abuse Unit worked with the DHS OIG to recover $270,576.18 from Option Care, $548,730.31 from University of Wisconsin Hospital Pharmacies, and $37,302.90 from Hemophilia Outreach Center.
Because these specialty pharmacies reimbursed Wisconsin Medicaid the amounts that the program overpaid, and no civil action was filed, requirements of 2017 Wisconsin Act 369 do not apply.