State reaps $385,000 in case similar to CoxHealth's

Missouri Attorney General Jay Nixon recovered $974,182 in a $37.5 million settlement with Gambro Healthcare Inc., which improperly billed Medicaid for home dialysis services in Missouri and 39 other states.

Missouri will receive $385,669 of the settlement; the remaining money will reimburse the federal government for its share of the state’s Medicaid funding.

The case alleged that Gambro improperly billed Medicaid for providing supplies and equipment to patients undergoing dialysis at home and billed Medicaid at a higher reimbursement rate than what was allowed under federal regulations.

Gambro entered into an agreement with the federal government last year and paid more than $308 million to settle civil liabilities for the billing fraud. Gambro also was fined $25 million in a St. Louis federal court in 2004 for the same offense.

According to court documents, Cox officials say they took notice of the case against Gambro and began to examine Cox’s similar dialysis services and Medicare billing methods.

“In December 2004, (CoxHealth) began to question the legality of its billing practice in light of a decision in United States v. Gambro Healthcare,” the court documents read.

This item originally appeared in the Sept. 21 issue of the SBJ e-news Daily Update.

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