For decades Medicaid and Medicare have been paying fraudulent claims bilking taxpayers while enriching the pharmaceutical companies. The drug companies use a variety of methods to defraud these Federal programs. Currently, there is much talk of sacrifices needing to be made, and budgets needing to be cut; but little is being said about stopping the FRAUD which continues unabated.

Indeed there is a case being considered in the US Supreme Court in which Amgen, is attempting to get the Court to legitimize a despicable practice reported today.
via BNET Placebo Effects by Jim Edwards:

Amgen Just Asked the Supreme Court to Legalize Kickbacks

Amgen (AMGN) is asking the U.S. Supreme Court to legalize kickbacks in the drug industry, calling the federal False Claims Act “draconian” because some courts say it doesn’t allow doctors to take a kickback before applying to Medicaid or Medicare for reimbursement.

If Amgen gets its way, drug companies will find it easier to reward doctors with cash or credit for using their drugs, and taxpayer-funded healthcare programs would have to reimburse them for it unless they did their own investigations to prove that kickbacks had been paid. read here.

Via Reuters David Morgan in Washington:

Analysis: States lobby against Medicaid cuts in Congress

An excerpt:

"State officials complain Medicaid is a problem because federal mandates make it hard for governors and lawmakers to address costs by adjusting benefits and eligibility." read here

Via The New York Times

To Save on Health Care, First Crack Down on Fraud

Published: September 26, 2011 By KATHLEEN SHARP

"LAST week, the Obama administration announced a plan to cut $320 billion over 10 years from the projected growth of Medicare and Medicaid. The plan would raise premiums and deductibles, lower payments to hospitals and require elderly people who receive care at home to make co-payments.

But before charging consumers more and eliminating valuable services, we should be much more aggressive in recovering money stolen from these taxpayer-supported programs. According to some estimates, health care fraud is a $250 billion-a-year industry, and about $100 billion of that is stolen from Medicare, the health care program for the elderly, and Medicaid, the insurance program for the poor and disabled." read here

I knew I couldn't be the only one to think that addressing the fraud and corruption is at least part of the solution!

There are two areas that State officials do have some control over: the payment of claims for "off-label" prescriptions, particularly for foster children, who are Wards of the State; and the drugs which are on it's "preferred list" for Medicaid and Medicare.

Here in Washington State, the psychiatric drugs on the Medicaid formulary include the "atypical" neuroleptic, or "antipsychotic" drugs. These more expensive drugs are identified as 'first-line treatments' for those on Medicaid. Why this is the case? It is known that the drugs are no better than less costly drugs. The drugs are no safer, nor more effective, yet they are "preferred." So why are they "preferred" for Medicaid and other Federal programs in Washington State?

The only plausible explanation is the preference is due to unethical Conflicts of Interest, and drug industry influence. As they say: follow the money. The primary beneficiaries of this arrangement, are the pharmaceutical companies and their stockholders. The Evidence Base for these newer psychiatric drugs does not in fact support "preferring" the new drugs over the older ones. The evidence base for using them for behavior issues for children is nonexistent.

The drugs are dangerous and cause impairments in normal healthy children--because it these very teratogenic drugs which disabled my son. The fact that these teratogenic drugs are being widely used in children. It makes me sick; sometimes I can't sleep knowing. The very drugs that disabled my son are being given to countless numbers of children; and like me, their parents are not told of the risks...

I have spoken to dozens of parents whose children are prescribed neuroleptic drugs--NOT A SINGLE ONE of the parents I have had contact with was told the drugs cause obesity, diabetes, heart disease, brain damage, and neurological impairments---NOT ONE was warned of these common negative effects; why are people not being told the information necessary to give Informed Consent? Some of their kids had become obese and have diabetes---none were told the drugs were the reason their child now had physical health issues.

Many of the drugs are the very same drugs that Washington, and other states have been successfully sued pharmaceutical companies for illegal marketing of the drugs. In spite of the fact the newer "atypical" neuroleptics are no safer or more efficacious, the drugs are still "preferred" by Washington Stat's Medicaid program. Services and programs are being cut, but no effort address Medicaid fraud or the unethical mental health practices which fuel it. There is no effort to stem the costs of prescribing more costly drugs which cause chronic diseases and neurological impairments which contribute to rising Medicaid costs...this is fiscally irresponsible; unethical, and morally repugnant.

The Amgen case is disappointing, it appears that it would serve to legitimize corrupt business practices. Should Amgen be successful, it would not bode well for the already strained Medicaid and Medicare programs---or for America in general, but it will cause more harm...