Earlier this month the U.S. Department of Justice (DOJ) announced an Oklahoma City-based specialty hospital and physician group will pay $72.3 million to resolve allegations under the False Claims Act and the Oklahoma Medicaid False Claims Act.
"Kickback schemes like this drain valuable resources from the federal and state healthcare systems, which go to our most vulnerable," said Oklahoma Attorney General Mike Hunter.
This is not the first time Oklahoma’s Medicaid system, also called SoonerCare, has faced fraud issues from providers.
Earlier this year, Jerry Terry of Mangum, Oklahoma was sentenced to three years in federal prison for defrauding Oklahoma’s Medicaid system and Medicare. According to the DOJ, Terry submitted false prescription drug claims to SoonerCare and Medicare Part D and he was ordered to pay $338,000 to SoonerCare for restitution.
Last year, an Edmond couple who operated Mercy Diabetics Supply were ordered to pay $268,000 for submitting false reimbursement claims to SoonerCare.
Medicaid fraud and mispayments can originate with enrollees as well. Last month, Governor Stitt released the findings of a state audit of Oklahoma’s Medicaid rolls and found that the Oklahoma Health Care Authority, the agency which oversees enrollment and administrative work for Oklahoma’s Medicaid program, was not able to properly determine eligibility for many Medicaid recipients.
A small sample projection from the audit found that $29.7 million in payments for services were made on behalf of individuals who did not qualify for Medicaid.
As Oklahoma’s Medicaid enrollment continues to grow and health care costs increase, it’s imperative that the state is able to weed out fraud whether stemming from providers or enrollees to ensure only that the state is only paying out proper benefits to those who are eligible for services.