Veritas_Intel

Forensic auditing. We have the receipts. BILLIONS+ in Unapproved Drug fraud the PBMs and the system don't want you to see. Whistleblower intelligence. 🇺🇸

[Veritas_Intel @verumfAI]

Texas paid PBMs to screen every Medicaid pharmacy claim.

502,442 claims for FDA-unapproved drugs got through anyway. $52 million, 2023 to 2025.

Not a rounding error. A gate that never closed.

Forensic Recovery Series, No. 1 of 51: TEXAS

[Veritas_Intel @verumfAI]

No PBM to blame here. The gatekeeper was the program itself.

Missouri must demand this back.

Next: Tennessee.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

The #1 best-selling prenatal vitamin in America costs $18.99 for a 90-day supply on Amazon. 21 cents a day.

Missouri Medicaid paid $484,206 for a prenatal product that was never FDA-approved, run entirely through the state's own fee-for-service channel.

105,166 unapproved claims total. $2.8 million, 2023 to 2025.

Forensic Recovery Series, No. 19 of 51: MISSOURI

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

105,166 unapproved-drug claims through state-run fee-for-service. $2,779,336 reimbursed.

Largest line item: a generic prenatal vitamin, NDC 39328010610. $484,206, never FDA-approved.

The comparator, receipt attached: #1 best seller in the category, USP verified, $18.99 for 90 days.

Statutory ceiling: $3.02B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

120,453 claims. The most of any state so far. Every one screened. Every one paid.

Washington must demand this back.

Next: Missouri.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Washington Medicaid processed 120,453 unapproved-drug claims through its PBM channel, the highest claim count in the series so far.

$2.9 million, 2023 to 2025. Every claim screened by a PBM paid to catch it.

Forensic Recovery Series, No. 18 of 51: WASHINGTON

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

120,453 unapproved-drug claims through the managed-care/PBM channel. $2,866,021 reimbursed.

Largest line item: a prenatal vitamin, NDC 39328010610, Patrin Pharma. The FDA's own listing, verbatim: "This drug has not been found by FDA to be safe and effective, and this labeling has not been approved by FDA."

$245,414 across 27,591 scripts. Paid anyway.

With 120,453 separate claims at $14,308 to $28,619 per claim, Washington's statutory ceiling is $3.46B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

No PBM to blame here. The gatekeeper was the program itself.

Colorado must demand this back.

Next: Washington.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Colorado Medicaid paid $453,369 for a single unapproved prenatal product, Complete Natal, run entirely through the state's own fee-for-service channel.

75,315 unapproved claims total. $3.4 million, 2023 to 2025.

Forensic Recovery Series, No. 17 of 51: COLORADO

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

75,315 unapproved-drug claims through state-run fee-for-service. $3,439,398 reimbursed.

Largest line item: Complete Natal, NDC 13811001030. $453,369, never FDA-approved.

A comparable prenatal with the same key nutrients, the #1 best seller in the category: $18.99 for a 90-day supply on Amazon. 21 cents a day.

Statutory ceiling: $2.17B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

No PBM to blame here. The gatekeeper was the program itself.

Wisconsin must demand this back.

Next: Colorado.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Wisconsin Medicaid paid $1 million for a single unapproved prenatal vitamin, Se-Natal 1, with no PBM in between.

96,503 unapproved claims total. $3.7 million, 2023 to 2025.

Forensic Recovery Series, No. 16 of 51: WISCONSIN

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

96,503 unapproved-drug claims through state-run fee-for-service. $3,662,854 reimbursed.

Largest line item: Se-Natal 1, NDC 13925011601. $1,002,359, never FDA-approved.

A comparable prenatal with the same key nutrients, the #1 best seller in the category: $18.99 for a 90-day supply on Amazon. 21 cents a day.

Statutory ceiling: $2.77B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

The state knows their names. So do the companies. $3.8 million still got through.

Arizona must demand this back.

Next: Wisconsin.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Arizona pays managed care plans to run its Medicaid drug benefit. Every plan hires a PBM to screen every claim.

98,511 unapproved claims got through anyway. $3.8 million, 2023 to 2025.

Forensic Recovery Series, No. 15 of 51: ARIZONA

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

98,511 unapproved-drug claims through the managed-care/PBM channel. $3,756,592 reimbursed.

Three PBMs on duty: CVS Caremark (Mercy Care, Molina Healthcare), Express Scripts (Banner University Family Care, Centene plans from 2024), Optum Rx (UnitedHealthcare Community Plan). Per AHCCCS pharmacy claims processing grids.

Largest line item: Armour Thyroid, NDC 00456046001, an unapproved thyroid hormone product. $419,329 across 4,739 scripts, $88.49 per script.

Statutory ceiling: $2.83B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

Same product. Different state. Same gatekeepers paid to catch it, didn't.

Illinois must demand this back.

Next: Arizona. Three named PBMs, one state.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Illinois is the second state this series has caught paying for the exact same unapproved lidocaine cream Michigan paid for.

26,144 prescriptions. $1.4 million on this one product. $4.6 million on unapproved drugs overall, 2023 to 2025.

Forensic Recovery Series, No. 14 of 51: ILLINOIS

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

129,998 unapproved-drug claims through the managed-care/PBM channel. $4,644,552 reimbursed.

Largest line item: lidocaine hydrochloride 3% cream, NDC 69367020285, the same product that led Michigan. $1,380,017 across 26,144 prescriptions, dispensed as one 85-gram tube per script, $52.79 each.

The identical 85-gram size, in a stronger 4% OTC formula: $4.36 on Amazon.

Statutory ceiling: $3.73B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).

[Veritas_Intel @verumfAI]

Nearly 280,000 claims. Every one screened by a gatekeeper paid to catch it. Every one paid.

Michigan must demand this back.

Next: Oklahoma.

Follow for all 50 states plus DC.

[Veritas_Intel @verumfAI]

Michigan Medicaid paid 34,810 prescriptions for a lidocaine cream the FDA never approved.

$1.3 million on this single product. $5.0 million on unapproved drugs overall, 2023 to 2025.

Forensic Recovery Series, No. 12 of 51: MICHIGAN

[Veritas_Intel @verumfAI]

The receipts, from CMS State Drug Utilization Data:

278,069 unapproved-drug claims through the managed-care/PBM channel. $4,981,339 reimbursed.

Largest line item: lidocaine hydrochloride 3% cream, NDC 69367020285. $1,312,279 across 34,810 prescriptions, dispensed as one 85-gram tube per script, $37.70 each.

The identical 85-gram size, in a stronger 4% OTC formula: $4.36 on Amazon.

With 278,069 separate claims, each a separate violation, Michigan's statutory ceiling is $7.97B (31 U.S.C. § 3729, 28 C.F.R. § 85.5).