A Medicaid fraud civil settlement will return $2.4 million to the Show-Me State.
Under the settlement terms, APS Healthcare Inc., APS Healthcare Bethesda Inc. and Innovative Resource Group LLC, dba APS Healthcare Midwest, agreed to immediately pay $5 million to Missouri and the federal government. The funding resolves allegations the companies submitted false claims to Missouri’s Medicaid program, according to a news release from Attorney General Chris Koster’s office.
From 2008 to 2010, APS was contracted to provide administrative services to two of Missouri’s Medicaid programs, the chronic care improvement plan and administrative services organization - which both ended in 2010. APS was required to assist management of care for chronically ill Medicaid beneficiaries in Missouri by coordinating preventive care to reduce overall costs from emergency care.
However, the companies allegedly failed to comply with contract terms of both programs related to beneficiary contact and billing requirements, thus submitting false claims to state Medicaid, according to the release.
Missouri and the federal government could receive up to an additional $10 million under the agreement.
That would happen if APS’ current owner, Universal American Corp., sells APS, or if UA recovers money in a federal lawsuit filed against Partners Healthcare Solutions Holding LP, which sold APS to UA in 2012, the release said.
Koster’s office worked with the U.S. Attorney’s office for the Eastern District of Missouri and the Department of Health & Human Services to secure the settlement.[[In-content Ad]]
Under the weight of rising health care costs, an increasing number of people are surging to the Health Insurance Marketplace rather than opting for employer-sponsored plans.
