Attorney General John O’Connor announced that a former Oklahoma-based medical supply company has agreed to pay $363,116 to resolve allegations that the company violated the Oklahoma Medicaid False Claims Act by inflating prices and shipping charges of durable medical equipment.
The company provided durable medical equipment and other services to Oklahoma Medicaid beneficiaries through a program administered by the Oklahoma Department of Human Services Developmental Disabilities Services Division. The settlement resolves certain allegations that the company submitted claims to the Oklahoma Medicaid program, known as “SoonerCare,” based on inflated pricing and shipping charges.
The Oklahoma Medicaid Fraud Control Unit (MFCU) began investigating the company after receiving a referral from a program manager at OKDHS Developmental Disabilities Services Division (DDSD). The DDSD works with clients who are physically challenged. The program manager became suspicious when the claims of the company were compared to claims from other companies that provided similar services and equipment.
“The Oklahoma attorney general’s office will always aggressively investigate these cases and partner with our local, state, and federal agencies to ensure those who commit Medicaid and Medicare fraud are held accountable,” said Attorney General O’Connor. “I commend our Medicaid Fraud Control Unit for successfully investigating this case and OKDHS Developmental Disabilities Services Division (DDSD) for their employee’s referral.”
Issue:
Medicare or Medicaid fraud occurs in several forms but is generally when a provider knowingly makes, or causes to be made, a false or misleading statement or representation for use in obtaining reimbursement from these government programs. Fraud also occurs when a provider attempts to charge recipients in excess of established rates or fails to maintain records for services provided. Facilities should be on the lookout for inflated prices from outside contractors. Failure to promptly report a false claim or kickback can result in lawsuits, fines, and other sanctions.
Discussion Points:
- Review policies and procedures that pertain to prevention and detection of fraud, waste, and abuse of federal and state funds. Update policies and procedures as needed.
- Train all staff on what may be considered fraud, waste, and abuse of government funds and the steps they should take if they suspect it has occurred. Ensure that staff understand that if they learn of activities which may involve excessive or unreasonable compensation or other substantial private benefits, they must report their concerns to the compliance and ethics officer, their supervisor, or through the Hotline.
- Periodically audit staff understanding to ensure they are knowledgeable about what is considered fraud, waste, and abuse of federal and state funds, and how they can report suspicions that it has occurred. Conduct audits of documentation and billing routinely to prevent and detect errors before they progress to a false claim. Confirm that vendors do not bill Medicare directly for items included in the facility’s required Medicare A consolidated billing, and that medical necessity for all claims is clearly identified.
