Oregon Department of Justice Expands Health Fraud Unit

March 30, 2010 -- Uncovering Medicaid fraud received a financial boost when Oregon’s Department of Justice increased its budget by half a million dollars.

 

The additional $506,703 enabled the department to hire Elizabeth Ballard, Morrow County’s District Attorney, along with support staff. Now the department has a $2 million budget. 

 

Attorney General John Kroger ranks Medicaid fraud as a high priority, according to Rodney Hopkinson, an attorney who runs the fraud unit. “We’re seeing the benefits,” Hopkinson said.

 

The additional funds come primarily from attorney fees recovered from a Medicaid fraud settlement. The unit has also hired a nurse investigator who specializes in reviewing medical and other technical documents.

 

“Until now we were limited on what we could read and understand,” Hopkinson said. “We didn’t know what we were looking for.” 

 

With these additional dollars, the unit can go beyond Medicaid fraud and investigate illegal activities such as abuse and neglect. “We’re expecting to expand more,” Hopkinson said, and continue adding staff. 

 

In 2008, the unit prosecuted 27 cases; in 2009, 21 cases. Last year alone, $20 million was recovered from pharmaceutical companies that defrauded Oregonians and the state’s Medicaid program, including $4.9 million of a $2.3 billion national settlement with Pfizer. That case represents the largest health fraud settlement in history. 

 

“We really got the most bang for the buck,” Hopkinson said, in terms of the money recovered by a four-attorney staff. Of those settlement dollars, Oregon’s Medicaid program received 60 percent, while the remainder was returned to the federal government.

 

Multi-state cases involving off-label marketing by pharmaceutical companies are the most common cases prosecuted by the fraud unit. It’s illegal to market drugs for uses other than what’s been approved by the Food and Drug Administration. The unit also prosecutes cases against doctors, dentists, hospitals, long-term care and hospice facilities, 

 

However that doesn’t stop pharmaceutical companies from engaging in what Hopkinson calls “secret campaigns” at industry conventions and lectures. “Doctors are free to prescribe drugs for whatever they want,” Hopkinson said.

 

Meanwhile, Ballard, who was elected Morrow County District Attorney in 2006, focused on prosecuting crimes related to meth such as dependency, property crimes and crimes of violence. She was also involved in the implementation of a drug court, and a diversion program for people charged with drug-related cases in 2009. 

 

Ballard became familiar with the fraud unit when Hopkinson prosecuted a case against Susan Pearson in Morrow County. Pearson, an in-home caregiver received Medicaid funds, and purportedly took care of Carolyn Elliot, her neighbor and co-defendant. Pearson was paid more than $100,000 in Medicaid funds over seven years because Elliot was unable to cook, walk without assistance or use the bathroom.

 

However, an investigation found that Elliot could perform all these activities. Pearson received a 39-month prison sentence. Elliott died one month before the trial. 

 

Ballard is convinced she’ll be more “proactive” as a prosecutor. By investigating fraud claims, she’s intent on stopping criminal acts. “By the time the district attorney gets involved, everything is said and done,” she said.

 

 

 

Do you suspect fraud has taken place? Call the Medicaid Fraud Unit’s tip line at 971-673-1880, and provide as many details as possible about the provider and the alleged fraud.