1. Erica J. Bailey, A.A.G. Chief of Civil Investigations
MFCU
Erica J. Bailey, A.A.G.
Chief of Civil Investigations

2. Overview
Methods for investigating civil Medicaid fraud cases involving pharmaceutical manufacturers
Coordination with other Medicaid Fraud Control Units (MFCU)
Coordination with the Federal government

3. Investigation Methods
Qui Tam Relators
CID/Subpoena
Data Analysis

4. Investigation Methods – Qui Tam Relator
Review pre-filing disclosure documents and exhibits provided by the relator in support of the fraud allegations.
Determine the credibility and strength of the relator’s allegations based on the interview.
Identify other witnesses that may have relevant information in support of the fraud allegations.
Identify other relevant documents that may support the fraud allegations.

5. Investigation Methods – CID/Subpoena
Civil Investigative Demand (CID) – Virginia Fraud Against Taxpayers Act, Va. Code Ann. § :
Produce such documentary material for inspection and copying,
Answer in writing written interrogatories with respect to such documentary material or information,
Give oral testimony concerning such documentary material or information,
Furnish any combination of such material, answers, or testimony.

6. Investigation Methods – CID/Subpoena
Medicaid Fraud Subpoena – Virginia Fraud Against Taxpayers Act, Va. Code Ann. § :
Conduct audits and investigations,
Issue subpoenas,
Take depositions,
Compel the production of pertinent books, payrolls, accounts, papers, records, documents and testimony relevant to such investigation.

7. Methods – Relevant Information Obtained by CID/Subpoena
Call notes
Training materials
Sales and marketing documents
Organizational charts
Studies sponsored by the company
s or internal correspondence
Witnesses interview reports
Deposition transcripts

8. Methods – Data Analysis
Determine the total Medicaid utilization (total dollars spent, as well as total number of claims) for the target drug,
Determine whether the patient was diagnosed with a condition the drug was approved to treat,
Determine whether the patient was switched from another drug to the target drug,
Determine physician prescribing trends, and
Determine the age of the patient at the time the drug was prescribed

9. Coordination with Other State MFCUs
National Association of Medicaid Fraud Control Units (NAMFCU)
Intake Teams
Investigation Teams
Global Case Teams
Litigation Teams

10. Coordination with the Federal Government
Includes joint investigation, settlement, and litigation with the Department of Justice and United States Attorney’s Offices.
42 C.F.R. § (e) provides, that “the unit will make available to Federal investigators or prosecutors all information in its possession concerning fraud in the provision or administration of medical assistance under the State plan and will cooperate with such officials in coordinating any Federal and State investigations or prosecutions involving the same suspects or allegations.”

11. QUESTIONS? Erica J. Bailey, A.A.G. Medicaid Fraud Control Unit
Virginia Attorney General’s Office
900 East Main Street Richmond, VA