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Office of Insurance Fraud
Prosecutor
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May 4, 2004 Attorney General Announces Glaxo SmithKline To Pay $2.1 Million
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TRENTON - Attorney General Peter C. Harvey announced that New Jersey's Medicaid Program will receive more than $2.1 million as a result of a national settlement which requires pharmaceutical giant Glaxo SmithKline to pay $87 million in damages and penalties to federal and state Medicaid programs. As part of the settlement, the Division of Criminal Justice - Office of Insurance Fraud Prosecutor's Medicaid Fraud Section separately negotiated an additional $850,608 to reimburse New Jersey's state-operated prescription drug programs. "This settlement returns a sizable amount of money to the State of New Jersey and to the various prescription drug programs which assist and benefit those citizens who need the aid the most. Every dollar lost to fraud or abuse is one less dollar available to help the most needy citizens of our state. The Insurance Fraud Prosecutor is committed to fighting healthcare fraud and returning much needed dollars to the state treasury," said Attorney General Harvey. According to Vaughn L. McKoy, Director, Division of Criminal Justice and Insurance Fraud Prosecutor Greta Gooden Brown, the national litigation alleged that Glaxo SmithKline sold pharmaceutical products to privately-operated health management organizations (HMO's) at deeply discounted prices, concealed the transactions, and then under-reported "best price" information to the Center for Medicaid and Medicare Services (CMS). The effect of this deception diminished the amount of money the company was required to pay federal and state Medicaid programs - thus cheating the states out of significant funding for prescription drug programs. Insurance
Fraud Prosecutor Gooden Brown noted that in order to receive Medicaid
reimbursement for drugs, pharmaceutical manufacturers enter into a
contract under the Medicaid Drug Rebate statute which requires the return
of monies to state and federal Medicaid programs in the form of rebates.
In order to calculate the amount of the rebate, pharmaceutical companies
must provide "best price" information to CMS - "best price" information
being the lowest price that a manufacturer offers a product for sale to
commercial purchasers. As a result of providing inaccurate "best price"
information, Glaxo SmithKline effectively discounted the amount of rebate
monies owed to the individual state Medicaid programs. According to Supervising Deputy Attorney John Krayniak, Office of Insurance Fraud Prosecutor's Medicaid Fraud Section, Glaxo avoided higher rebate payments by re-labeling or re-packaging certain drugs under private HMO labels. For example, under a private labeling agreement with California-based HMO Kaiser Permanente, Glaxo manufactured, packed and shipped Flonase to Kaiser, substituting Kaiser's identification number for the Glaxo identification number. The result of the private labeling arrangement was to allow Kaiser additional price discounts on Flonase without having to report the discounted price as Glaxo's "best price," thus allowing Glaxo to avoid paying higher rebates to the state Medicaid programs. Similarly, Glaxo SmithKline provided Kaiser discount prices on Paxil without reporting the discounted price to CMS in order to avoid paying higher Medicaid rebates. Krayniak said that New Jersey is one of the few states in the country that administers Medicaid as well as state-funded pharmaceutical assistance programs - the Pharmaceutical Assistance to the Aged and Disabled (PAAD) and the Senior Gold Program. As with Medicaid, the state-sponsored programs require pharmaceutical manufacturers to adhere to the same "best price" rules in order to participate in the PAAD and Senior Gold programs. Based on this requirement, the Medicaid Fraud Section of the Office of Insurance Fraud Prosecutor separately negotiated and received an additional $850,608 as part of the Glaxo SmithKline settlement. In 2003, the Office of Insurance Fraud Prosecutor filed 5,524 civil complaints, consent orders, judgements, and/or other actions which resulted in the assessment of more than $16.2 million in sanctions, fines and restitution. A national study released by the Washington, D.C.-based Coalition Against Insurance Fraud in December reported that New Jersey's Office of Insurance Fraud Prosecutor accounted for 86 percent of the total civil actions reported in 2002 by all 43 state insurance fraud bureaus included in the report. The Office of Insurance Fraud Prosecutor also ranks as a national leader in the filing of criminal cases. In 2003, the Office of Insurance Fraud Prosecutor charged 337 defendants via 215 criminal indictments and accusations; compared to 225 defendants charged in 173 indictments and/or accusations in 2002. "Insurance fraud is among our top priorities," said Attorney General Harvey. "We have dedicated significant resources to investigating and prosecuting insurance fraud to stabilize insurance rates in New Jersey. We're fighting insurance fraud on three fronts: criminal prosecution, civil sanctions and forfeiture of the licenses of professionals who engage in insurance fraud. We've used that triple threat to make our Office of Insurance Fraud Prosecutor one of the nation's foremost fraud fighting agencies."
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