Cox Files Charges against Pharmacy for Medicaid Fraud SchemeContact: John Sellek or Joy Yearout 517-373-8060
July 1, 2010
LANSING - Attorney General Mike Cox today announced charges filed against a Mattawan pharmacist accused of operating a fraudulent Medicaid billing scheme. Edward Nantais, a licensed pharmacist, is the owner and operator of Mattawan Pharmacy, which is also charged in the case. Under the scheme, Nantais and Mattawan Pharmacy billed Michigan Medicaid for expensive prescriptions that were never actually dispensed to Medicaid patients.
"As Michigan families struggle to earn every dollar they send to Lansing, we must be diligent in our efforts to root out fraud and waste in government," said Cox. "Fighting Medicaid fraud ensures taxpayer dollars are used efficiently, and most importantly, ensures Michigan residents receive needed medical services."
An investigation by Attorney General Mike Cox's Health Care Fraud Division found that Nantais filed over $35,000 in fraudulent Medicaid billings from 2006 through 2009. The drugs in question are Valcyte, Zyvox, and Abilify. In one instance, Nantais billed Medicaid $7,217.87 for one prescription of Valcyte (180 tablets) that the Medicaid recipient never received. Not only did the patients never receive the drugs, but their physicians never prescribed them. In some cases, the pharmacy never even purchased from its wholesaler the drugs it allegedly dispensed.
The Michigan Medicaid program was not the only victim in this scheme. CVS Caremark, a pharmacy benefits manager, conducted an audit on behalf of its clients and determined that Nantais fraudulently billed private insurers, as well as the federal Medicare Program in excess of $1,750,000 over the same time period.
Agents from the Attorney General's office worked with federal and local authorities to execute a search warrant on June 9, 2010 at Nantais' home and business.
Nantais and Mattawan Pharmacy are each charged with 16 counts of felony Medicaid Fraud, four years and/or $50,000 each. Nantais will be arraigned at the 54B District Court in East Lansing today at 1:00 PM.
"I would like to thank the U.S. Department Health & Human Services - Office of Inspector General, the U.S. Attorney's Office for the Western District, Mattawan Village Police Department, St. Joseph County Sheriff's Department, and the Michigan Department of Community Health for their assistance and cooperation in this investigation," said Cox.
Efforts by Cox's Medicaid Fraud Control Unit have recovered a record $173 million since he took office, more than nine times the amount collected by Michigan's previous two attorneys general.
A criminal charge is merely an accusation and defendants are presumed innocent unless proven guilty beyond a reasonable doubt.
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