Medicaid Fraud Audit Targets Schizophrenia Drug

First, lawmakers in Utah expressed concern over the state’s Medicaid expenditures.  Then, Utah State health officials were asked to investigate and control alleged fraud.  Now, critics are questioning whether measures went too far, and some are expressing a sentiment that these audits paint an inaccurate picture of fraud…the millions of dollars sought to be recouped by officials stem from clerical errors and involve anti-psychotic drugs used by Schizophrenics. 

As a result of an audit that targeted dozens of the largest pharmacies in Utah, The Salt Lake Tribune reported that millions of dollars’ worth of drugs were paid for by Medicaid, but should not have been. 

We are not talking about drugs that usually make headlines.  Seroquel (also known as Quetiapine), is an anti-psychotic, and was one of two drugs at the center of the audit. 

“Quetiapine tablets and extended-release (long-acting) tablets are used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions),” according to the National Center for Biotechnology Information.

Authorities in Utah say anti-psychotic drugs worth $1.2 million were billed to Medicaid, but should not have been.

This may serve as a wakeup call and could lead to more clerical oversight, but will it do anything to really bring costs under control? That much remains to be seen.

“Medicaid spends more on atypical antipsychotics than any other drug class,” say Utah health authorities.

The Tribune quotes one pharmacy owner as saying, “we’re talking about a situation where the right medications are going to the right patients as prescribed. Is that fraud?” 

Image: Pixomar /

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About Evan H Farr, CELA, CAP

Evan H. Farr is a 4-time Best-Selling author in the field of Elder Law and Estate Planning. In addition to being one of approximately 500 Certified Elder Law Attorneys in the Country, Evan is one of approximately 100 members of the Council of Advanced Practitioners of the National Academy of Elder Law Attorneys and is a Charter Member of the Academy of Special Needs Planners.

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