MEDICAID has a set fee. They could have paid $50 for the pills and billed $600. They would have been paid $26, PERIOD.
There can only be fraud here if they upcoded; provided a lesser item, but billed for a more expensive item. That is the most commons type of fraud to MEDICAID and MEDICARE.
It is the low fees for MEDICAID services that have made many providers to stop participating in the program. I'm in DME, (durable medical equipment) some the devices physicians order and patients rightfully need are reimbursed at less than cost. MEDICAID sucks for all involved.
As does Medicare and Tricare Life.
Tricare Life shut out private pharmacies in 2014 with a DOD MANDATE to get daily meds from Military base dispensary that is not handicapped set up, or Express Scripts.Very cumbersome system, You fill at the base, and refills come from Pensacola, for our district. Takes 5 days, ES takes 2 weeks. 2015 they made the Pilot Program PERMANENT.
ES just shoves your meds in a plastic sack into your mail box UN PHOTO ID SIGNED for.l I’ve had to sign for a $3.00 Amazon item, Our 5 ES provided 90 day meds have a retail cost of $4,500. Co-pays vary by drug. The drugs are dangerous if kids got into them. It will take an act of congress to stop the stupidity. When a simple order from DOD would do it. SIGN FOR them.