Minnesota Home Healthcare Company to Pay More Than $700,000 to Resolve False Claims Act Liability
A home healthcare company headquartered in Minnesota has agreed to pay $726,957.59 to resolve Federal False Claims Act violations arising from the unlawful submission of claims for payment to Minnesota Medicaid, a jointly funded federal and state healthcare program.
According to the settlement agreement, the home healthcare company voluntarily disclosed to the United States that it had submitted claims for payment for home care services to both Minnesota Medicaid and private insurers for the same service, and fraudulently retained full payment from Minnesota Medicaid, even where it was not the primary insurer. The company worked cooperatively with the Department of Justice in voluntarily disclosing the false claims. Department of Justice policy encourages self-reporting of fraud and values company cooperation.
Compliance Perspective
Knowingly submitting claims for reimbursement of the same home care services to both Medicaid and private insurers, and fraudulently retaining full payment from Medicaid when it is not the primary payor, may result in fines and sanctions for violating the False Claims Act.
Discussion Points:
- Review policies and procedures regarding the required protocols for returning funds received for wrongly submitted claims.
- Train billing office staff to prevent the submission in error of duplicate claims to both government services and private insurers.
- Audit submitted claims periodically to discover the presence of any duplicate submissions. Audit any notifications received from government services requesting the return of claims reimbursed in error to determine if they have been returned according to required protocols.
FRAUD MODULE 7 – AUDITING, MONITORING, RESPONDING, INVESTIGATING AND LITIGATION RESPONSIBILITIES
