Unlocking Medicaid fraud can be as tortuous and labyrinthine a process as making sense of the legislation itself. Often, grandiosity characterizes elaborate institutional methods involving private entities bilking the government out of untold billions that essentially are absorbed by the government even after prosecution of the offenders — only adding to the cost outlay of the entitlement program.

Alternatively, fraud indirectly involving Pharma is fast becoming an issue because, for certain populations, Medicaid has been responsible for much of the cost of care delivery via drugs — many of which are branded. Where the legislation should draw the line, however, is in the unauthorized use of many of those medications explicitly granted a warning by the FDA as prohibited. Drugs used to treat mental illness — particularly as unauthorized in children, and reimbursible under Medicaid — fall squarely within this class of rules.

Nowhere is this occurring as rapidly as in the child foster care system, in which these children — often burdened with multiple placements, obvious parental neglect, and the influence of illicit drugs and criminal environments — are exposed to rather abusive prescribing practices by providers using psychotropics to treat what amounts to a troubled lifestyle … instead of frank mental illness. | LINK

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