Palm Beach Post Staff Writer
Updated: 9:39 a.m. Wednesday, May 25, 2011
Posted: 7:19 a.m. Wednesday, May 25, 2011
The state Attorney General's Office is looking into whether doctors who have contracted with Florida's Juvenile Justice Department committed Medicaid fraud while working for the state.
Attorney General Pam Bondi's office is contacting Juvenile Justice and other agencies to gather information, Bondi spokeswoman Jennifer Krell Davis said Tuesday. She stressed that the effort has just begun, and it was uncertain what the review might turn up.
"If any information comes to light that would indicate Medicaid fraud, then we would certainly investigate any of those activities," Davis said.
The scrutiny follows publication of a Palm Beach Post investigation, which found that Florida has medicated children in state custody with heavy doses of antipsychotic pills. Published Sunday and Monday, the stories also showed that doctors who diagnose and prescribe drugs for kids in custody have taken huge speaker fees from companies that make antipsychotic pills.
DJJ pays for drugs prescribed to children in the department's 25 jails statewide, and in state-operated residential programs that house high- and maximum-risk offenders. But psychiatrists hired to work in programs for low- and moderate-risk kids can bill Medicaid or private insurance for prescriptions.
One in three of the psychiatrists who have worked for DJJ in the past five years took speaker fees or gifts from drug firms that make anti-psychotics, The Post found.
The payments totaled more than $250,000 over two years.
"I'm sure there will be some eyes opened and some attention donated to that," said state Sen. Greg Evers, R-Crestview, chairman of the Senate's Criminal Justice Committee. "This is extremely upsetting, from a parent, from a taxpayer, from a member of the legislature, on all accounts."
Proving Medicaid fraud can be tough, said Ryan Stumphauzer, a former assistant U.S. attorney who prosecuted health care fraud. In general, to make such a case, the government has to show that doctors billed providers for drugs that weren't medically necessary.
"A fundamental concept of Medicare and Medicaid is that they only pay for medical items and services that are reasonable and necessary for the health of the patient," said Stumphauzer, now in private practice in Miami. "If very heavy psychiatric medications were not medically necessary for the health of the patient and were submitted with some fraudulent intent, then that would be fraud."
Reacting to The Post's findings this month, DJJ Secretary Wansley Walters ordered a wide-ranging investigation into the department's use of anti-psychotic medications. DJJ's chief medical director, Dr. Lisa Johnson, issued a strongly worded memo urging doctors to weigh risks before prescribing medications.
As the state probe continues, and the attorney general asks questions, lawmakers, including Evers, said they are paying close attention.
"I'm appalled at the situation. We should not be medicating for convenience," said Evers, who said his office is in close contact with Walters. "I'm very upset to find this situation as it is today. But it will be changed."