U.S. Senator Charles Grassley

Post and Courier
Health providers to repay $1.9 million – Improper billing to Medicaid cited
By Renee Dudley
March 14, 2012

More than 30 South Carolina health care providers must repay nearly $1.9 million they inappropriately billed to the state Medicaid agency, according to state health officials and documents recently obtained by The Post and Courier.

The repayment demand stems, in part, from an investigation of doctors’ prescribing habits for painkillers and antipsychotics.

Three of the providers must appear before the state Board of Medical Examiners, and their licenses could be revoked, according to documents prepared by the S.C. Department of Health and Human Services.

The state also referred three providers to the Medicaid Fraud Control Unit in the S.C. attorney general’s office. State Medicaid officials declined to say whether those are the same three providers who will appear before the medical board.

The state declined to identify the providers in question. The attorney general’s office could not be reached Tuesday.

The state already has recovered about $1.7 million from the providers, Health and Human Services spokesman Jeff Stensland said. Stensland said he did not know when the state began receiving repayments.

The state’s February report was prompted by a nationwide investigation by U.S. Sen. Charles Grassley, R-Iowa. Grassley sought information from each state about doctors who have the highest rates of prescribing commonly abused prescription drugs to people enrolled in Medicaid, the government-funded health insurance program for the poor and disabled.

The state, per Grassley’s request, in 2010 compiled a list of the 10 providers who billed Medicaid the highest amounts for each of eight prescription drugs during 2008 and 2009, according to the documents. State officials investigated 34 of the 83 providers who appeared on those lists for possible Medicaid abuses.

More recently, the state has opened investigations into an additional 13 cases of possible abuses among Medicaid providers, according to the documents. Those probes are ongoing.

The state “conducts ongoing data mining to identify fraud and abuse in the Medicaid program that takes into account many factors besides the number of prescriptions written by an individual physician,” S.C. Medicaid Director Tony Keck said in a Feb. 10 letter to Grassley.