National Association for Rights Protection and Advocacy

Medicaid Fraud Claims Challenging Practice of Prescribing Off-Label Drugs to Children

James B. (Jim) Gottstein, J.D.

Most of the psychiatric drugs prescribed to children and youth on Medicaid are not properly paid for by Medicaid because they are not for a "medically accepted indication" as defined in the Medicaid statute.  This means it is Medicaid Fraud. Under the False Claims Act, anyone with "non-public" knowledge may bring a lawsuit on behalf of the government and share in the recovery, if any.  In 2009, PsychRights launched its Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth, including publishing a model complaint, to encourage people to bring these suits as a way to curb the out-of-control psychiatric drugging of poor children and youth.  In United States v. King-Vassel, 728 F.3d 707 (7th Cir. 2013), the 7th Circuit validated PsychRights' legal analysis, holding (a) off-label prescriptions presented to Medicaid  for payment not otherwise supported by one of the drug references known as "compendia" are (generally) false claims, and (b) doctors knowingly  cause the false claims, and therefore liable, by writing such prescriptions if they know the patient is a Medicaid recipient (unless they come forward with evidence to the contrary). 

Goals and Objectives

1.       This workshop will explain the provisions and background of the Medicaid Fraud Initiative Against Psychiatric Drugging of Youth. 

2.      This workshop will also present the nuts and bolts of prosecuting such cases. 

3.      The presenter will also describe the trials and tribulations of the cases already brought.

  PsychRights Medicaid Fraud Initiative Against Psychiatric Drugging of Children & Youth 

Link to brief presenter bio:

James B. (Jim) Gottstein, J.D.