by Ben Vernia | February 1st, 2011
The Department of Justice announced on February 1 that Dayton, Ohio-based CareSource (and related companies) have agreed to pay $26 million to settle claims that they defrauded Medicaid. According to DOJ’s press release:
CareSource, CareSource Management Group Co. and CareSource USA Holding Co. have agreed to pay the United States and the state of Ohio $26 million to resolve allegations that they caused Medicaid to make payments for assessments and case managements they failed to provide to children and adults, the Justice Department announced today.
CareSource, which is headquartered in Dayton, Ohio, provides managed care benefits to Medicaid beneficiaries in Ohio, Indiana and Michigan. The settlement resolves allegations that between January 2001 and December 2006, the CareSource entities knowingly failed to provide required screening, assessment and case management for adults, and children with special health care needs. As a result, it was alleged that CareSource received millions of dollars in Medicaid funds to which it was not entitled. The CareSource entities subsequently submitted false data to the state of Ohio so that it appeared they were providing these required services to improperly retain incentives received from Ohio Medicaid and to avoid penalties.
The case was brought by two whistleblowers, former employees of CareSource, who will receive a relator’s share (of the unidentified federal portion of the settlement) of approximately $3.1 million.
