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Losing Opportunities to Recover Money for Worker Health and Welfare Funds

In settling False Claims Cases involving pharmaceutical industry misbranding and kickbacks, are State Attorney Generals leaving money on the table? The answer is maybe.

Most FCA settlements compensate for lost Medicaid and Medicare dollars. Left out of the mix are losses incurred by state and municipal health and welfare funds. Undoubtedly the money left on the table is not insignificant.

Why does this occur? One reason is that most state AG’s assign investigation of pharma fraud to Medicaid Fraud Control units. And larger investigations are coordinated among state AG’s through the National Association of Medicaid Fraud Control Units (NAMFCU). The result seems to be that no one is watching out for the interests of  public employee health and welfare funds at the state and federal level.

With public employee health and welfare funds strapped for cash and looking to meet rising drug costs, the oversight is not immaterial. It is an oversight that should raise questions from health and welfare fund trustees. Public employee unions which bargain for dollars to fund healthcare costs should pay particular attention. Where a municipal fund needs cash to make ends meet, the shortfall generally means that workers will get the short end of the stick when it comes time to negotiating a new labor agreement.

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