Pfizer's millions fund state's new Medicaid whistleblower plan

State investigators can't hire people to peer over the shoulders of every doctor, pharmacist and home health care owner who may be stealing from the Medicaid program. But they can entice people to become informers.

The state Legislature created a program this spring to reward people whose tips lead to fines, civil or criminal charges or forfeiture of property in Medicaid fraud cases. Earlier this month, Attorney General Bill McCollum announced the program will get $1 million from the government's settlement with drug company Pfizer.

Three weeks ago, the drug company agreed to pay $2.3 billion to settle federal allegations that it illegally marketed its painkiller Bextra and other drugs. Florida's share of the settlement is $58 million.

The $1 million money for informants will help "prime the pump" on the new Medicaid fraud program, said state Sen. Don Gaetz, R-Destin, who sponsored the fraud legislation this spring.

"We expect to recover many millions of dollars in overpaid claims and fraudulent and abusive practices in Medicaid because of those who want to drop a dime on bad actors," Gaetz said.

Gaetz said his bill is aimed at a broad range of things, from keeping drug felons from working near hospital drug supplies to tracking Medicaid providers' prescription and billing practices. It also creates a list of all Medicaid providers sanctioned or terminated from the program.

Medicaid is the state and federal program that pays for health care for more than 3 million low-income Floridians. Its costs exceeded $16 million last year, and state auditors estimated that five to 20 percent of that total is lost to overbilling, false claims and other fraudulent practices.

In May, federal officials accused WellCare Health Plans Inc. of a multimillion dollar scheme to defraud Florida Medicaid and Florida Healthy Kids Corp. Federal officials say the Tampa company, one of the nation's largest administrators of Medicare and Medicaid benefits, diverted millions to a subsidiary to avoid returning unused money to the state.

The company agreed to pay $80 million in restitution and civil penalties.

The state has implemented half a dozen measures over the years to curb Medicaid fraud. In 2008, the Legislature passed a bill increasing oversight of home health agencies and nurse registries that provided Medicaid services.

This year's bill is the first to bring together law enforcement and health agencies to deal with Medicaid fraud, including the Department of Health, which licenses health care providers, and the Agency for Health Care Administration, which process Medicaid payments.

"We never had that," Gaetz said. "Nor did we have an effective system of inducing and using information from people who see bad acts going on. But now we do."

In addition to bringing out information on civil fraud, the program will help the attorney general develop criminal cases that hinge on inside information, said Ryan Wiggins, spokeswoman for the Attorney General's Office.

It "gives us a string to pull on to determine whether there is criminal activity," Gaetz said.

If the information is original and leads to a recovery, an informant can receive up to 25 percent of the recovered amount, up to $500,000 per case.

The Attorney General's Office said it will protect informants' identities. Rewards will be paid only after a case has been resolved.

People with knowledge of Medicaid fraud may call the attorney general's fraud hotline, (866) 966-7226 or (850) 414-3990.