Georgia Medicaid Provider and Its Owner to Pay $10.1 Million for Medicaid False Claims
Judgments of $10.1 million were recently assessed to settle a civil fraud complaint filed by the federal government and the state of Georgia against a Medicaid provider and its owner. The judgments approved by the U.S. District Court for the Southern District of Georgia awards the government $9.7 million from the Medicaid provider and $400,000 from the owner.
The complaint was filed in July 2018 and alleged that the Medicaid provider violated the False Claims Act and the Georgia False Medicaid Claims Act by filing thousands of false or fraudulent non-emergency transportation and adult day health services claims, and also falsified thousands of records to cover up their false Medicaid claims.
The Medicaid provider and the owner consented to the judgments against them and to the amounts of the judgments.
Compliance Perspective
Submitting claims for Medicaid reimbursement of non-emergency transportation, fraudulent claims for adult day health services, and falsifying thousands of records to cover up those false claims is considered a violation of federal and state False Claims Acts, resulting in fines and exclusion as a Medicaid provider.
Discussion Points:
- Review policies and procedures regarding the filing of Medicaid claims and the services that are eligible for reimbursement.
- Train staff regarding preventing the submission of claims for excluded or unnecessary services, and to report any concerns that the claims or records are inappropriate or falsified to their supervisor or via the Hotline.
- Periodically audit submitted claims to determine that they are appropriate and represent necessary services.
FRAUD MODULE 3: MASTERING LEGAL IMPLICATIONS AND ANTITRUST LAWS
