A not-for-profit Medicaid managed care plan in Ohio agreed this week to pay that state and the federal government $26 million to resolve whistleblower allegations by former employees that for six years the plan falsely billed for special needs assessments and case management services that weren’t provided, the Department of Justice announced.
CareSource, and its related CareSource Management Group Co. and CareSource USA Holding Co., acknowledged the settlement in a statement but denied any wrongdoing. The company is headquartered in Dayton, and provides managed care benefits to about 880,000 Medicaid and Medicare Advantage beneficiaries in Ohio, Indiana and Michigan.
The settlement resolves allegations that between January 2001 and December 2006, CareSource knowingly failed to provide required screening, assessment and case management for adults, and children with special healthcare needs, even though the plan billed and was paid millions of dollars for those services, state and federal prosecutors said.
CareSource allegedly submitted false data to the state of Ohio so that it appeared they were providing the required services to improperly retain incentives received from Ohio Medicaid and to avoid penalties, prosecutors said.
“Cash-strapped Medicaid programs, such as Ohio’s, can ill afford conduct such as this, designed to improve this company’s bottom line at the expense of a program benefitting the poor and disabled,” said Tony West, assistant attorney general for the Civil Division.
CareSource President /CEO Pamela Morris said the plan denied the allegations throughout the litigation process. “In the end, we chose to reach a financial settlement, bringing the matter to a close, and continuing to focus on our mission of making a difference in the lives of underserved people by improving their healthcare,” she said.